Transcatheter aortic valve replacement in bicuspid aortic valve disease

Abstract

BACKGROUND Limited information exists describing the results of transcatheter aortic valve (TAV) replacement in patients with bicuspid aortic valve (BAV) disease (TAV-in-BAV). OBJECTIVES This study sought to evaluate clinical outcomes of a large cohort of patients undergoing TAV-in-BAV. METHODS We retrospectively collected baseline characteristics, procedural data, and clinical follow-up findings from 12 centers in Europe and Canada that had performed TAV-in-BAV. RESULTS A total of 139 patients underwent TAV-in-BAV with the balloon-expandable transcatheter heart valve (THV) (n 48) or self-expandable THV (n 91) systems. Patient mean age and Society of Thoracic Surgeons predicted risk of mortality scores were 78.0 8.9 years and 4.9 3.4%, respectively. BAV stenosis occurred in 65.5%, regurgitation in 0.7%, and mixed disease in 33.8% of patients. Incidence of type 0 BAV was 26.7%; type 1 BAV was 68.3%; and type 2 BAV was 5.0%. Multislice computed tomography (MSCT)-based TAV sizing was used in 63.5% of patients (77.1% balloon-expandable THV vs. 56.0% self-expandable THV, p 0.02). Procedural mortality was 3.6%, with TAV embolization in 2.2% and conversion to surgery in 2.2%. The mean aortic gradient decreased from 48.7 16.5 mm Hg to 11.4 9.9 mm Hg (p < 0.0001). Post-implantation aortic regurgitation (AR) grade $ 2 occurred in 28.4% (19.6% balloon-expandable THV vs. 32.2% self-expandable THV, p 0.11) but was prevalent in only 17.4% when MSCT-based TAV sizing was performed (16.7% balloon-expandable THV vs. 17.6% self-expandable THV, p 0.99). MSCT sizing was associated with reduced AR on multivariate analysis (odds ratio [ OR]: 0.19, 95% confidence intervals [ CI]: 0.08 to 0.45; p < 0.0001). Thirty-day device safety, success, and efficacy were noted in 79.1%, 89.9%, and 84.9% of patients, respectively. One-year mortality was 17.5%. Major vascular complications were associated with increased 1-year mortality (OR: 5.66, 95% CI: 1.21 to 26.43; p 0.03). CONCLUSIONS TAV-in-BAV is feasible with encouraging short-and intermediate-term clinical outcomes. Importantly, a high incidence of post-implantation AR is observed, which appears to be mitigated by MSCT-based TAV sizing. Given the suboptimal echocardiographic results, further study is required to evaluate long-term efficacy. (J Am Coll Cardiol 2014; 64: 2330-9) c 2014 by the American College of Cardiology Foundation.