The Presence of Calcified Raphe Is an Independent Predictor of Adverse Long-Term Clinical Outcomes in Patients With Bicuspid Aortic Stenosis Undergoing Transcatheter Aortic Valve Replacement

Abstract

ObjectiveCurrent guidelines recommend that transcatheter aortic valve replacement (TAVR) for bicuspid aortic valve (BAV) with aortic stenosis (AS) should only be performed in selected patients. However, we consider it even more crucial to identify what the really important factors are while determining long-term outcomes in patients with BAV undergoing TAVR, which is precisely the aim of this study.MethodsWe retrospectively evaluated consecutive patients who underwent TAVR with balloon-expandable Sapien XT or Sapien 3 valves (Edwards Lifesciences, Irvine, CA) for the treatment of severe bicuspid AS. The primary end points were major adverse cardiac and cerebral events (MACCE), that is, mortality, non-fatal myocardial infarction (MI), disabling stroke, valve failure needing reintervention, or clinically relevant valve thrombosis during follow-up.ResultsA total of 56 patients who underwent TAVR with Sapien XT (n = 20) or Sapien 3 (n = 36) were included. The device and procedural success rates were similar between the two TAVR valves; however, the newer-generation Sapien 3 yielded a trend toward better long-term clinical outcomes than the early-generation Sapien XT did (MACCE rates 35 vs. 11%, p = 0.071). In the multivariate Cox proportional hazards analyses, the presence of calcified raphe > 4 mm was the only independent predictor of long-term MACCE (hazard ratio: 6.76; 95% confidence interval: 1.21–37.67, p = 0.029).ConclusionTAVR performed by a skilled heart team, while using newer-generation balloon-expandable Sapien 3 valve, may yield better long-term clinical outcomes compared to TAVR using early-generation Sapien XT valve. Moreover, the presence of calcified raphe >4 mm is an independent determinant of adverse clinical outcomes.

One-Year Outcomes after Myval Implantation in Patients with Bicuspid Aortic Valve Stenosis—A Multicentre Real-World Experience

“…Multiple factors might affect the clinical and haemodynamic outcomes, such as the severity of the calcification [ 14 , 22 ], the residual AR, and the transprosthetic gradient.…”

Clinical outcomes and cumulative healthcare costs of TAVR vs. SAVR in Asia

“…Early valve technologies included CoreValve (Medtronic Inc., Minneapolis, MN), Lotus (Boston Scientific, Natick, MA), and Sapien XT (Edwards Lifesciences, Irvine, CA), which were launched, respectively, in 2012, 2015, and 2016. New-generation TAVR devices, including Evolut R (Medtronic Inc., Minneapolis, MN), Sapien 3 (Edwards Lifesciences, Irvine, CA) and Portico (Abbott Vascular Inc., Santa Clara, CA), all of which were introduced in 2017 ( 20 ). Most of the TAVR operations during the study period (2015–2019) involved new-generation devices.…”