Transcatheter aortic valve replacement for patients with severe bicuspid aortic stenosis

Pineda, Andrés M.; Rymer, Jennifer; Wang, Alice; Banks, Adam; Koweek, Lynne; Plichta, Ryan P.; Williams, Adam R.; Vavalle, John P.; Halim, Sharif; Kiefer, Todd L.; Wang, Andrew; Gaca, Jeffrey G.; Hughes, G. Chad; Harrison, J. Kevin

doi:10.1016/j.ahj.2020.02.003

Cited by 16 publications

(21 citation statements)

References 20 publications

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“…The PPI rate following TAVR for BAV has been reported from 8.0% to 18% regardless of the used THV (8,24 ) and from 13.1% to 17.6% with balloon-expanding SAPIEN 3 THV (11,25,26 ). When comparing the incidence of PPI with tricuspid valve, the results were not consistent through the studies; one retrospective study showed a higher PPI rate in the BAV group (5 ), and the others demonstrated no significant differences between 2 groups (8 -10, 27 ).…”

Section: Permanent Pacemaker Implantation Ratementioning

confidence: 99%

Predictors of Conduction Disturbances after Transcatheter Aortic Valve Implantation with Balloon-expandable Valve for Bicuspid Aortic Valve Stenosis

Miyashita

Moriyama

Yamanaka

et al. 2021

Preprint

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Objective: The implantation depth and membranous septum (MS) length are established as the predictors of new-onset conduction disturbance (CD) after transcatheter aortic valve replacement (TAVR) for tricuspid aortic valve (TAV) stenosis. However, little is known about the predictors with bicuspid aortic valve (BAV). This study investigated the role of MS length and implantation depth in predicting CD following TAVR with a balloon-expandable valve in patients with BAV. Methods and results: This retrospective study analyzed 169 patients who underwent TAVR for BAV with balloon-expandable valve, and TAV cohort was established as a control group using propensity score (PS) matching. The primary endpoint was in-hospital new-onset CD (new-onset left bundle branch block or new permanent pacemaker implantation). New-onset CD developed in 37 patients (21.9%). Multivariate analysis revealed severe LVOT calcification (Odds ratio [OR]: 5.83, 95% confidence interval [CI]: 1.08 – 31.5, p = 0.0407) and implantation depth – MS length (OR: 1.30, 95% CI: 1.12 – 1.51, p = 0.0005) as the predictors of new-onset CD within BAV cohort. The matched comparison between BAV and TAV groups showed similar MS length (3.0 vs 3.2mm, p = 0.5307), but valves were implanted deeper in BAV than TAV group (3.9 vs 3.0mm, p < .0001). New-onset CD was more frequent in patients having BAV (22.3% vs 13.9%, p = 0.0458). Conclusion: The implantation depth - MS length, and severe LVOT calcification predicted new-onset CD following TAVR in BAV with balloon-expandable valve. High implantation technique could be considered to avoid new-onset CD in BAV anatomy.

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Section: Permanent Pacemaker Implantation Ratementioning

confidence: 99%

Predictors of Conduction Disturbances after Transcatheter Aortic Valve Implantation with Balloon-expandable Valve for Bicuspid Aortic Valve Stenosis

Miyashita

Moriyama

Yamanaka

et al. 2021

Preprint

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“…A total of 14924 patients(BAV: 4986 patients; TAV: 9938 patients) in 20 studies [11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30] were eligibility for the current meta analysis. According to the Newcastle-Ottawa Scale(0-9), 18 studies represented high quality(a score of[?]…”

Section: Resultsmentioning

confidence: 99%

“…19 studies [11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][27][28][29][30] reported post-procedural MAG, and 7 studies 11,[14][15][16][17]25,27 reported post-procedural AVA. The data of MAG in the 15 studies 11,[13][14][15][16][17]20,[22][23][24][25][27][28][29][30] and AVA in all the 7 studies were expressed as the mean±SD(n), and were taken into comparison independently.…”

Section: Comparison Of Efficacy Endpointsmentioning

confidence: 99%

“…The data of MAG in the 15 studies 11,[13][14][15][16][17]20,[22][23][24][25][27][28][29][30] and AVA in all the 7 studies were expressed as the mean±SD(n), and were taken into comparison independently. 4 studies 12,18,19,21 were excluded because the data were expressed as median and interquatile range. Post-procedural MAG tended to be similar between BAV and TAV group(MD 0.15, 95%CI -0.06-0.36, I 2 =46%).…”

Section: Comparison Of Efficacy Endpointsmentioning

confidence: 99%

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Efficacy and safety of Transcatheter Aortic Valve Replacement in patients with stenotic bicuspid aortic valve: a meta-analysis

Wang

Zhang

et al. 2022

Preprint

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Objective: To assess clinical outcomes of Transcatheter Aortic Valve Replacement in stenotic bicuspid aortic valve patients. Methods: The search of clinical articles was conducted by using Pubmed, Embase, The Cochrane Library databases. We compared clinical outcomes of efficacy and safety endpoints between stenotic bicuspid aortic valve(BAV) and tricuspid aortic valve(TAV) patients according to Valve Academic Research Consortium-2 criteria. Results: 20 studies were included in the current meta analysis. BAV groups showed higher post-procedural paravalvular leakage and stroke rate compared with TAV groups. No discrepancy were detected in the mean aortic gradient and aortic valve area between two groups. The 30-day and 1-year mortality were similar in both groups. BAV group was more likely to be associated with lower device success and higher incidence of conversion to surgical aortic valve replacement, second valve implantation and annular rupture. No difference was found in the incidence of permanent pacemaker implantation, acute kidney disease, life-threatening bleeding and myocardial infarction between bicuspid and tricuspid patients. Conclusion: The efficacy and safety of TAVR in BAV patients were not as ideal as those in TAV patients. Cautious and adequate discussion must be made before we decide to perform TAVR procedure for BAV patients.

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“…Nevertheless, 2 large studies proved that nowadays life expectancy of BAV patients does not differ from the general population [ 5 , 6 ]. Similarly, recent multicenter registry-based studies indicate that patients with BAV stenosis have similar TAVI outcomes as patients with TAV stenosis [ 7 – 10 ]. With over 150 TAVI procedures in BAV since 2009 and more than 10 years of follow-up, our institution has developed substantial expertise with this patient population.…”

Section: Introductionmentioning

confidence: 97%

Ten-year experience with transcatheter aortic valve implantation in bicuspid aortic valve: lessons learned and future perspectives

Walczewski

Huczek

Rymuza

et al. 2021

pwki

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Bicuspid aortic valve (BAV) stenosis has traditionally been perceived as a contraindication to transcatheter aortic valve implantation (TAVI) due to its specific anatomical characteristics including extensive calcifications, high leaflet coaptation and frequently encountered aortic root dilation, which may result in worse procedural outcomes and higher risk of complications. Hence, BAV patients were not included in previous clinical trials. In the recent years, improved pre-procedural imaging and technological advances have gradually enabled expansion of TAVI to patients with complex anatomy, including those with BAV. Moreover, indications for TAVI are expanding to a younger group of patients with fewer comorbidities, and BAV is more prevalent in this population. Contemporary multicenter registry-based studies indicate that patients undergoing TAVI for BAV have similar outcomes as those with tricuspid aortic valve stenosis. In this article, we provide a thorough overview of the available clinical data regarding the outcomes of TAVI in BAV, from the perspective of an experienced TAVI center with over 150 TAVIs in this group of patients, performed in our institution since the year 2009. We present anatomical and clinical classifications of BAV, differences in outcomes in patients with bicuspid and tricuspid valves, as well as important topics regarding choice of an adequate valve and valve size.

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Transcatheter aortic valve replacement for patients with severe bicuspid aortic stenosis

Cited by 16 publications

References 20 publications

Predictors of Conduction Disturbances after Transcatheter Aortic Valve Implantation with Balloon-expandable Valve for Bicuspid Aortic Valve Stenosis

Predictors of Conduction Disturbances after Transcatheter Aortic Valve Implantation with Balloon-expandable Valve for Bicuspid Aortic Valve Stenosis

Efficacy and safety of Transcatheter Aortic Valve Replacement in patients with stenotic bicuspid aortic valve: a meta-analysis

Ten-year experience with transcatheter aortic valve implantation in bicuspid aortic valve: lessons learned and future perspectives

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