Brain Injury After Transcatheter Replacement of Bicuspid Versus Tricuspid Aortic Valves

Fan, Jiaqi; Fang, Xuekun; Liu, Chunhui; Zhu, Gangjie; Hou, Cody R.; Jiang, Jianwen; Lin, Xianming; Wang, Lihan; He, Yuxin; Zhu, Qionghua; Ng, Stella; Chen, Zexin; Hu, Haitao; Liu, Xianbao; Wang, Jianan; Leon, Martin B.

doi:10.1016/j.jacc.2020.09.605

Cited by 36 publications

(33 citation statements)

References 35 publications

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“…5,9 The embolic burden appears to increase with increasing aortic valve calcification, bicuspid valves, specific procedural characteristics like balloon postdilation, and type of transcatheter valve (self-expanding valve more than balloon-expandable). 10,11 Cerebral protection devices (CPDs) have been developed to decrease the cerebral embolic burden by trapping the debris. In December 2017, the Sentinel Cerebral Protection System became the only CPD approved by the Food and Drug Administration for use in the United States (US).…”

Section: Introductionmentioning

confidence: 99%

Use and outcomes of cerebral embolic protection for transcatheter aortic valve replacement: A US nationwide study

Khan

Zahid

Khan

et al. 2021

Cathet Cardio Intervent

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Background: Outcomes data on the use of cerebral embolic protection devices (CPDs) with transcatheter aortic valve replacement (TAVR) remain limited. Previous randomized trials were underpowered for primary outcomes of stroke prevention and mortality. Methods:The National Inpatient Sample and Nationwide Readmissions Database were queried from 2017 to 2018 to study utilization and inpatient mortality, neurological complications (ischemic stroke, hemorrhagic stroke, and transient ischemic attack), procedural complications, resource utilization, and 30-day readmissions with and without use of CPD. A 1:3 ratio propensity score matched model was created.Results: Among 108,315 weighted encounters, CPD was used in 4380 patients (4.0%). Adjusted mortality was lower in patients undergoing TAVR with CPD (1.3% vs. 0.5%, p < 0.01). Neurological complications (2.5% vs. 1.7%, p < 0.01), hemorrhagic stroke (0.2% vs. 0%, p < 0.01) and ischemic stroke (2.2% vs. 1.4%, p < 0.01) were also lower in TAVR with CPD. Multiple logistic regression showed CPD use was associated with lower adjusted mortality (odds ratio (OR], 0.34 [95% confidence interval [CI], 0.22-0.52), p < 0.01) and lower adjusted neurological complications (OR, 0.68 (95% CI, 0.54-0.85], p < 0.01). On adjusted analysis, 30-day all-cause readmissions (Hazard ratio, HR 0.839, [95% CI, 0.773-0.911], p < 0.01) and stroke (HR, 0.727 [95% CI, 0.554-0.955), p = 0.02) were less likely in TAVR with CPD. Conclusion:We report real-world data on utilization and in-hospital outcomes of CPD use in TAVR. CPD use is associated with lower inpatient mortality, neurological, and clinical complications as compared to TAVR without CPD.

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Section: Introductionmentioning

confidence: 99%

Use and outcomes of cerebral embolic protection for transcatheter aortic valve replacement: A US nationwide study

Khan

Zahid

Khan

et al. 2021

Cathet Cardio Intervent

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“…The inclusion flow chart of the current study is shown in Figure 1. Six studies (1,239 patients) were enrolled to compare the procedural and clinical outcomes of TAVI between the Sievers type 0 and type 1 BAV (8,13,(19)(20)(21)(22). The bias risk of the enrolled studies was generally low based on the Newcastle-Ottawa scale criteria (…”

Section: Resultsmentioning

confidence: 99%

Transcatheter Aortic Valve Implantation in Sievers Type 0 vs. Type 1 Bicuspid Aortic Valve Morphology: Systematic Review and Meta-Analysis

Wang

Liu

et al. 2021

Front. Cardiovasc. Med.

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Background: Transcatheter aortic valve implantation (TAVI) has achieved satisfactory outcomes in the selected patients with bicuspid aortic valve (BAV), predominately type 1 BAV (~90%). However, there are few reports about the safety and efficacy of TAVI in type 0 BAV. Therefore, in the current study, we aimed to compare procedural and 30-day outcomes after TAVI between type 0 and type 1 BAV.Methods: Studies comparing the outcomes of TAVI in Sievers type 0 vs. type 1 BAV were retrieved from PubMed, EMBASE, Cochrane Library, and Web of Science from inception to May 2021. The data were extracted regarding the study characteristics and outcomes. The odds ratios (ORs) with 95% CIs were pooled for procedural and 30-day outcomes.Results: Six observational studies were included with determined type 0 BAV in 226 patients and type 1 BAV in 902 patients. The patients with type 0 BAV were slightly younger, had larger supra-annular structure, and more frequently implanted self-expanding prosthesis compared with type 1 BAV. In the pooled analyses, the patients with type 0 BAV had a similar incidence of procedural death (OR = 2.6, 95% CI 0.7–10.3), device success (OR = 0.6; 95% CI 0.3–1.3), and ≥ mild (OR = 0.8; 95% CI 0.4–1.6) or moderate (OR = 0.9, 95% CI 0.4–1.8) paravalvular leak, whereas significantly higher mean aortic gradient (mean difference = 1.4 mmHg, 95% CI 0.03–2.7) and increased coronary compromise risk (OR = 7.2; 95% CI 1.5–34.9), compared with type 1 BAV. Meanwhile, the incidence of death (OR = 1.2; 95% CI 0.5–3.1), stroke (OR = 0.5; 95% CI 0.1–2.4), and new pacemaker (OR = 0.6; 95% CI 0.2–2.2) at 30 days were not significantly different between the BAV morphologies (p > 0.05). The treatment effect heterogeneity across the studies for the above outcomes were low.Conclusions: The patients with type 0 BAV appear to have similar short-term outcomes after TAVI compared with type 1 BAV. Whereas, TAVI for type 0 BAV aortic stenosis might lead to an elevated coronary obstruction risk and suboptimal aortic valvular hemodynamics.

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“…Patients with bicuspid valves are a particular challenge due to their asymmetric, elliptical annulus that often hasasymmetriccalcification.DespitethelackofRCTs,observational studies show that TAVRs are being performed on the bicuspid population, and a large recent analysis showed high rates of success. However, as would be expected, bicuspid aortic valves have greater paravalvular leak 11 and a higher risk of cerebral embolism 12,13 compared with tricuspid valve replacements. Therefore, we should temper the recommendations for TAVR with a comprehensive Heart Team approach, especially in younger patients who are likely to require additional aortic valve procedures in the future.…”

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confidence: 75%

TAVR or SAVR: Unfinished Business

Resar

2021

Innovations�(Phila)

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Brain Injury After Transcatheter Replacement of Bicuspid Versus Tricuspid Aortic Valves

Cited by 36 publications

References 35 publications

Use and outcomes of cerebral embolic protection for transcatheter aortic valve replacement: A US nationwide study

Use and outcomes of cerebral embolic protection for transcatheter aortic valve replacement: A US nationwide study

Transcatheter Aortic Valve Implantation in Sievers Type 0 vs. Type 1 Bicuspid Aortic Valve Morphology: Systematic Review and Meta-Analysis

TAVR or SAVR: Unfinished Business

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