Bicuspid Aortic Valve Anatomy and Relationship With Devices: The BAVARD Multicenter Registry

Tchétché, Didier; Biase, Chiara De; Gils, Lennart van; Parma, Radosław; Ochała, Andrzej; Lefèvre, Thierry; Hovasse, Thomas; Backer, Ole De; Søndergaard, Lars; Bleiziffer, Sabine; Lange, Rüdiger; Kornowski, Ran; Landes, Uri; Nørgaard, Bjarne Linde; Biasco, Luigi; Philippart, Raphaël; Nicolás, Javier Molina-Martín de; Mylotte, Darren; Lemee, Caroline; Dumonteil, Nicolas; Mieghem, Nicolás M. Van

doi:10.1161/circinterventions.118.007107

Cited by 143 publications

(117 citation statements)

References 25 publications

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“…(Figure B). As a consequence, annular based CT sizing as performed in our study seems to be accurate also for BAV and is supported by recent CT data from the BAVARD Multicenter Registry . Also, our patients experienced significant improvement in heart failure symptoms with most patients in NYHA functional class I/II shortly after the index procedure (91%) and at last follow up (93%; Figure A).…”

Section: Discussionsupporting

confidence: 85%

Mid‐term outcome in patients with bicuspid aortic valve stenosis following transcatheter aortic valve replacement with a current generation device: A multicenter study

Attinger‐Toller

Bhindi

Perlman

et al. 2019

Cathet Cardio Intervent

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Objectives: To perform clinical and echocardiographic follow-up beyond 1 year in consecutive patients with severe bicuspid aortic stenosis (AS) undergoing transcatheter aortic valve replacement (TAVR) with a current generation balloon-expandable valve.Background: Treatment of bicuspid aortic valve disease with TAVR remains controversial and late follow-up data is still scarce. Methods:We collected baseline characteristics, procedural data, 30-day and midterm clinical follow-up findings from six centers in Europe and Canada from patients with bicuspid AS treated with TAVR using the SAPIEN 3 valve.Results: Seventy-nine patients underwent TAVR. Mean age was 76 ± 9 years; median STS risk score for mortality was 3.8% (interquartile range 2.3-5.5%). Median follow-up was 390 days (interquartile range 138-739 days). Device success was achieved in 95% of patients. Postimplantation mean aortic gradient decreased from 50.2 ± 16.2 to 8.8 ± 4.4 mmHg and no patient had more than mild aortic regurgitation. At last follow-up, there was persistent good valve performance. At 30 days and 1 year, the rates of allcause mortality were 3.8 and 7.7%, stroke 1.2 and 1.2%, and the rate of new pacemakers 18 and 18%.Conclusions: Our data confirm that treating patients with stenotic bicuspid aortic valves is safe, effective, and has favorable valve performance over time.aortic valve disease percutaneous intervention, paravalvular leak, structural heart disease intervention, transcatheter valve implantation Transcatheter aortic valve replacement (TAVR) has emerged as the preferred treatment modality for many patients with severe aortic stenosis (AS). 1-6 However, the great majority of data demonstrating efficacy and safety of TAVR derives from patients with tricuspid aortic valve morphology. Treatment of bicuspid aortic valve (BAV) disease with TAVR remains controversial. 7 BAV is a heritable defect found in 0.5-2% of the population. [8][9][10] Due to younger age at presentation and anatomical complexity, bicuspid AS has been excluded from major randomized trials comparing TAVR to surgical aortic valve replacement (SAVR). However, 2-6% of patients in large clinical registries have bicuspid AS. 11,12 Anatomical challenges associated with BAV include larger aortic annuli, severe and asymmetric leaflet and annular calcification, altered geometry, and dilation of the ascending aorta. 9,[13][14][15] In 2010, the first series of patients with BAV treated with early TAVR devices confirmed feasibility. 16 Typically, residual aortic regurgitation (AR) and periprocedural complications have been more common in patients with bicuspid AS undergoing TAVR. [16][17][18][19] However, this data is based on observational studies, in most of which, early generation devices were used. Perlman et al 20 demonstrated favorable periprocedural and 30-day outcomes in patients with BAV undergoing TAVR with the SAPIEN 3 valve, suggesting superior results with newergeneration devices. Subsequently, Yoon et al demonstrated improved procedural outcomes with the SAPIEN 3 val...

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Section: Discussionsupporting

confidence: 85%

Mid‐term outcome in patients with bicuspid aortic valve stenosis following transcatheter aortic valve replacement with a current generation device: A multicenter study

Attinger‐Toller

Bhindi

Perlman

et al. 2019

Cathet Cardio Intervent

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“…In addition, an intercommissural distance method can be used in grey zones as well as when intercommissural distance is smaller than the mean annular diameter. 3 …”

Section: Discussionmentioning

confidence: 99%

Embolization to Two Different Vascular Territories in a Patient With Bicuspid Aortic Stenosis Undergoing Transcatheter Aortic Valve Implantation

2020

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We describe the case of an 81-year-old man with symptomatic severe bicuspid aortic valve stenosis. Transfemoral transcatheter aortic valve implantation was performed with a cerebral embolic protection device. During valve deployment, the 29-mm Evolut PRO prosthesis (Medtronic) popped out 3 times and exchanged for a 34-mm Evolut R. Large valvular debris were captured in the embolic protection device. Subsequently, the patient developed chest pain and electrocardiogram modification. An emergency coronary angiography showed an occlusion of the middle circumflex artery. This case demonstrates technical challenges and possible complications in patients with bicuspid aortic valve stenosis undergoing transcatheter aortic valve implantation.

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“…Bicuspid valves often have heavy asymmetric calcification, associated aortopathy, and present unique anatomical challenges for TAVR due to the often non-circular implantation of the transcatheter heart valve (THV) [ 11 – 13 ]. These challenges may increase the risk of periprocedural complications including annular rupture, asymmetric valve deployment, and paravalvular leak (PVL), which may all impact short- and long-term outcomes with TAVR [ 14 ].…”

Section: Anatomic Factors Favoring Savrmentioning

confidence: 99%

“…However, conversion to open surgery, peri-procedural stroke, and need for PPM continue to remain significantly higher in bicuspid patients with newer-generation THVs [ 18 ]. Computed tomography (CT) studies of implanted THVs in patients with bicuspid AS have found suboptimal, non-circular valve expansion in bicuspid patients, which may impact long-term valve performance and the rate of valve degeneration [ 14 ].…”

Section: Anatomic Factors Favoring Savrmentioning

confidence: 99%

Expansion of TAVR into Low-Risk Patients and Who to Consider for SAVR

et al. 2020

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Transcatheter aortic valve replacement (TAVR) has revolutionized the treatment of severe aortic stenosis (AS) over the last decade. The results of the Placement of Aortic Transcatheter Valves (PARTNER) 3 and Evolut Low Risk trials demonstrated the safety and efficacy of TAVR in low-surgical-risk patients and led to the approval of TAVR for use across the risk spectrum. Heart teams around the world will now be faced with evaluating a deluge of younger, healthier patients with severe AS. Prior to the PARTNER 3 and Evolut Low Risk studies, this heterogenous patient population would have undergone surgical aortic valve replacement (SAVR). It is unlikely that TAVR will completely supplant SAVR for the treatment of severe AS in patients with a low surgical risk, as SAVR has excellent short- and long-term outcomes and years of durability data. In this review, we outline the critical role that SAVR will continue to play in the treatment of severe AS in the post-PARTNER 3/Evolut Low Risk era.

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Bicuspid Aortic Valve Anatomy and Relationship With Devices: The BAVARD Multicenter Registry

Cited by 143 publications

References 25 publications

Mid‐term outcome in patients with bicuspid aortic valve stenosis following transcatheter aortic valve replacement with a current generation device: A multicenter study

Mid‐term outcome in patients with bicuspid aortic valve stenosis following transcatheter aortic valve replacement with a current generation device: A multicenter study

Embolization to Two Different Vascular Territories in a Patient With Bicuspid Aortic Stenosis Undergoing Transcatheter Aortic Valve Implantation

Expansion of TAVR into Low-Risk Patients and Who to Consider for SAVR

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