Predictors of high residual gradient after transcatheter aortic valve replacement in bicuspid aortic valve stenosis

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  • Giulia Bugani
  • Matteo Pagnesi
  • Didier Tchetchè
  • Won Keun Kim
  • Arif Khokhar
  • Jean Malte Sinning
  • Uri Landes
  • Ran Kornowski
  • Pablo Codner
  • Georg Nickenig
  • Alfonso Ielasi
  • Chiara De Biase
  • Federico De Marco
  • Marco Ancona
  • Matteo Montorfano
  • Damiano Regazzoli
  • Giulio Stefanini
  • Stefan Toggweiler
  • Corrado Tamburino
  • Sebastiano Immè
  • Giuseppe Tarantini
  • Horst Sievert
  • Ulrich Schäfer
  • Jörg Kempfert
  • Jochen Wöehrle
  • Maurizio Tespili
  • Alessandra Laricchia
  • Azeem Latib
  • Francesco Giannini
  • Antonio Colombo
  • Antonio Mangieri

Objectives: To define the incidence of high residual gradient (HRG) after transcatheter aortic valve replacement (TAVR) in BAVs and their impact on short term outcome and 1-year mortality. Background: Transcatheter heart valves (THVs) offer good performance in tricuspid aortic valves with low rate of HRG. However, data regarding their performance in bicuspid aortic valves (BAV) are still lacking. Methods: The BEAT (Balloon vs Self-Expandable valve for the treatment of bicuspid Aortic valve sTenosis) registry included 353 consecutive patients who underwent TAVR (Evolut R/PRO or Sapien 3 valves) in BAV between June 2013 and October 2018. The primary endpoint was device unsuccess with post-procedural HRG (mean gradient ≥ 20 mmHg). The secondary endpoint was to identify the predictors of HRG following the procedure. Results: Twenty patients (5.6%) showed HRG after TAVR. Patients with HRG presented higher body mass index (BMI) (30.7 ± 9.3 vs. 25.9 ± 4.8; p < 0.0001) and higher baseline aortic mean gradients (57.6 ± 13.4 mmHg vs. 47.7 ± 16.6, p = 0.013) and more often presented with BAV of Sievers type 0 than patients without HRG. At multivariate analysis, BMI [odds ratio (OR) 1.12; 95% confidence interval (CI) 1.05–1.20, p = 0.001] and BAV type 0 (OR 11.31, 95% CI 3.45–37.06, p < 0.0001) were confirmed as independent predictors of high gradient. Conclusion: HRG following TAVR in BAVs is not negligible and is higher among patients with high BMI and with BAV 0 anatomy. Graphic abstract: [Figure not available: see fulltext.].

OriginalsprogEngelsk
TidsskriftClinical Research in Cardiology
Vol/bind110
Udgave nummer5
Sider (fra-til)667-675
Antal sider9
ISSN1861-0684
DOI
StatusUdgivet - 2021

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© 2021, Springer-Verlag GmbH Germany, part of Springer Nature.

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