TY - JOUR

T1 - Procedural and clinical outcomes of type 0 versus type 1 bicuspid aortic valve stenosis undergoing trans-catheter valve replacement with new generation devices

T2 - Insight from the BEAT international collaborative registry

AU - Ielasi, Alfonso

AU - Moscarella, Elisabetta

AU - Mangieri, Antonio

AU - Giannini, Francesco

AU - Tchetchè, Didier

AU - Kim, Won-Keun

AU - Sinning, Jean-Malte

AU - Landes, Uri

AU - Kornowski, Ran

AU - De Backer, Ole

AU - Nickenig, Georg

AU - De Biase, Chiara

AU - Søndergaard, Lars

AU - De Marco, Federico

AU - Bedogni, Francesco

AU - Ancona, Marco

AU - Montorfano, Matteo

AU - Regazzoli, Damiano

AU - Stefanini, Giulio

AU - Toggweiler, Stefan

AU - Tamburino, Corrado

AU - Immè, Sebastiano

AU - Tarantini, Giuseppe

AU - Sievert, Horst

AU - Schäfer, Ulrich

AU - Kempfert, Jörg

AU - Wöehrle, Jochen

AU - Latib, Azeem

AU - Calabrò, Paolo

AU - Medda, Massimo

AU - Tespili, Maurizio

AU - Colombo, Antonio

N1 - Copyright © 2020 Elsevier B.V. All rights reserved.

PY - 2021

Y1 - 2021

N2 - BACKGROUND: Although bicuspid aortic valve (BAV) is not considered a "sweet spot" to trans-catheter aortic valve replacement (TAVR), a certain number of BAV underwent TAVR. Whether BAV phenotype affects outcomes following TAVR remains debated. We aimed at evaluating the impact of BAV phenotype on procedural and clinical outcomes after TAVR using new generation trans-catheter heart valves (THVs).METHODS: patients included in the BEAT registry were classified according to the BAV phenotype revealed at multi-slice computed tomography (MSCT) in type 0 (no raphe) vs. type 1 (1 raphe). Primary end-point was Valve Academic Research Consortium-2 (VARC-2) device success. Secondary end-points included procedural complications, rate of permanent pacemaker implantation, clinical outcomes at 30-day and 1-year.RESULTS: Type 0 BAV was present in 25(7.1%) cases, type 1 in 218(61.8%). Baseline characteristics were well balanced between groups. Moderate-severe aortic valve calcifications at MSCT were less frequently present in type 0 vs. type 1 (52%vs.71.1%,p = 0.05). No differences were reported for THV type, size, pre and post-dilation between groups. VARC-2 success tended to be lower in type 0 vs. type 1 BAV (72%vs86.7%;p = 0.07). Higher rate of mean transprosthetic gradient ≥20 mmHg was observed in type 0 vs. type 1 group (24%vs6%,p = 0.007). No differences were reported in the rate of post-TAVR moderate-severe aortic regurgitation and clinical outcomes between groups.CONCLUSIONS: Our study confirms TAVR feasibility in both BAV types, however a trend toward a lower VARC-2 device success and a higher rate of mean transprosthetic gradient ≥20 mmHg was observed in type 0 vs. type 1 BAV.

AB - BACKGROUND: Although bicuspid aortic valve (BAV) is not considered a "sweet spot" to trans-catheter aortic valve replacement (TAVR), a certain number of BAV underwent TAVR. Whether BAV phenotype affects outcomes following TAVR remains debated. We aimed at evaluating the impact of BAV phenotype on procedural and clinical outcomes after TAVR using new generation trans-catheter heart valves (THVs).METHODS: patients included in the BEAT registry were classified according to the BAV phenotype revealed at multi-slice computed tomography (MSCT) in type 0 (no raphe) vs. type 1 (1 raphe). Primary end-point was Valve Academic Research Consortium-2 (VARC-2) device success. Secondary end-points included procedural complications, rate of permanent pacemaker implantation, clinical outcomes at 30-day and 1-year.RESULTS: Type 0 BAV was present in 25(7.1%) cases, type 1 in 218(61.8%). Baseline characteristics were well balanced between groups. Moderate-severe aortic valve calcifications at MSCT were less frequently present in type 0 vs. type 1 (52%vs.71.1%,p = 0.05). No differences were reported for THV type, size, pre and post-dilation between groups. VARC-2 success tended to be lower in type 0 vs. type 1 BAV (72%vs86.7%;p = 0.07). Higher rate of mean transprosthetic gradient ≥20 mmHg was observed in type 0 vs. type 1 group (24%vs6%,p = 0.007). No differences were reported in the rate of post-TAVR moderate-severe aortic regurgitation and clinical outcomes between groups.CONCLUSIONS: Our study confirms TAVR feasibility in both BAV types, however a trend toward a lower VARC-2 device success and a higher rate of mean transprosthetic gradient ≥20 mmHg was observed in type 0 vs. type 1 BAV.

KW - Aortic Valve/diagnostic imaging

KW - Aortic Valve Stenosis/diagnostic imaging

KW - Bicuspid Aortic Valve Disease

KW - Catheters

KW - Constriction, Pathologic

KW - Humans

KW - Registries

KW - Transcatheter Aortic Valve Replacement/adverse effects

KW - Treatment Outcome

U2 - 10.1016/j.ijcard.2020.10.050

DO - 10.1016/j.ijcard.2020.10.050

M3 - Journal article

C2 - 33148461

VL - 325

SP - 109

EP - 114

JO - International Journal of Cardiology

JF - International Journal of Cardiology

SN - 0167-5273

ER -