Transcatheter Aortic Valve Replacement in Bicuspid Versus Tricuspid Aortic Valves From the STS/ACC TVT Registry

Transcatheter and surgical aortic valve replacement in patients with bicuspid aortic valve

“…Makkar et al [ 14 ] demonstrated in 2691 propensity score-matched pairs from the Society of Thoracic Surgeons (STS)/American College of Cardiology (ACC) Transcatheter Valve Therapies Registry comparable 30-day and 1-year survival with TAVR in patients with BAV and tricuspid aortic valve. Similar results were reported from the same registry by Forrest et al [ 21 ] among patients treated with self-expandable Evolut R or Evolut PRO prostheses.…”

“…This means that BAV patients are expected to have a long-life expectancy after intervention and TAVR in these patients should be performed only when high device success, low rate of PVR and prosthesis durability are guaranteed. These issues explain why the prevalence of BAV in TAVR cohorts were much lower than in the SAVR cohorts and ranged from 3.3% to 5.4% in two recent studies [14,21], which are comparable to the prevalence of BAV in the present TAVR cohort (4.8%).…”

International Consensus Statement on Nomenclature and Classification of the Congenital Bicuspid Aortic Valve and Its Aortopathy, for Clinical, Surgical, Interventional and Research Purposes

“…There were no differences in mortality, symptom improvement, PVL and valve haemodynamics, but there was an increase in 30-day strokes and periprocedural complications requiring surgery in the BAV cohort. A recent study reported on 929 propensity matched pairs (bicuspid versus tricuspid) with self-expandable TAVR devices; the researchers found no difference in 30-day or 1-year all-cause death or stroke; however, patients with a bicuspid valve undergoing TAVR were more likely to require aortic valve reintervention at both 30 days and 1 year compared to patients with tricuspid valve undergoing TAVR [127]. Finally, the Bicuspid AS TAVR Registry, which included 1,034 patients with analyses of CCT images [128] showed that patients with a calcified raphe or excess leaflet calcification had increased early mortality and higher rates of periprocedural complications including aortic root injury and moderate or severe PVL (Fig.…”

Robotic aortic valve replacement

“…21 Reardon, co-principal investigator in the CoreValve trials (Medtronic), and colleagues 22 have further postulated that when viewing the existing low-risk trial data in the aggregate, the generalizability of existing data to all populations remains limited, given the current lack of evaluable evidence outside the important limited parameters of the trials, and the durability of TAVR valves in younger patients remains unknown. Finally, although bicuspid valve intervention is beginning to be explored with equivocal results, 23 questions remain as to the relative impact of hypoattenuating leaflet thickening and microthrombosis on TAVR durability, 24 especially when the 5-year data on intermediate-risk patients now reveal that PVL, need for reintervention, and longitudinal outcomes may begin to slightly favor SAVR over TAVR. 25 Collectively, there exist several clinical situations in which data to inform the management of aortic valve disease is either lacking or equipositional.…”