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JACC Cardiovasc Interv. 2016 Apr 25;9(8):817-824. doi: 10.1016/j.jcin.2016.01.002.

Bicuspid Aortic Valve Stenosis: Favorable Early Outcomes With a Next-Generation Transcatheter Heart Valve in a Multicenter Study.

Author information

1
Department of Cardiology, St. Paul's Hospital, Vancouver, British Columbia, Canada.
2
Departments of Radiology and Cardiology, University Heart Center Freiburg-Bad Krozingen, Germany.
3
Department of Cardiovascular Surgery, Hôpital Cardiologique, Lille, France.
4
Department of Cardiology, Ferrarotto Hospital, University of Catania, Catania, Italy.
5
Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland.
6
Department of Cardiovascular Surgery, University Heart Center, Hamburg, Germany.
7
Ospedale Civico, Palermo, Italy.
8
Cardiovascular Department, Institute of Cardiology, University of Bologna, Policlinico St. Orsola-Malpighi, Bologna, Italy.
9
Department of Cardiology, St. Paul's Hospital, Vancouver, British Columbia, Canada. Electronic address: John.webb@vch.ca.

Abstract

OBJECTIVES:

This study evaluated the results of transcatheter aortic valve replacement (TAVR) in bicuspid aortic stenosis (AS) using a new-generation TAVR device.

BACKGROUND:

A bicuspid AS is often considered a relative contraindication to TAVR. Although initial reports have demonstrated feasibility using early-generation devices, outcomes have not matched those seen with tricuspid AS. Paravalvular aortic regurgitation (AR) has been particularly problematic.

METHODS:

We collected baseline characteristics, procedural data, and 30-day clinical follow-up findings from 8 centers in Europe and Canada that had performed TAVR in bicuspid AS using the SAPIEN 3 valve.

RESULTS:

51 patients underwent TAVR using the SAPIEN 3 valve. Patient mean age was 76.2 ± 9.3 years and the Society of Thoracic Surgeons predicted risk of mortality scores were 5.2 ± 3.7%. Bicuspid valve types were: type 0, 11.8%; type 1, 82.3%; and type 2, 1.9%. There were no cases of valve embolization or need for a second valve. Post-dilation was performed in 7.8%. The mean aortic gradient decreased from 49.4 ± 16.0 mm Hg to 11.2 ± 4.7 mm Hg. Post-implantation AR was none/trivial in 63% and mild in 37%. There were no cases of moderate or severe AR. At 30-day follow-up, there were 2 deaths (3.9%), 2 major vascular complications, and 12 patients (23.5%) required pacemaker implantation.

CONCLUSIONS:

TAVR in bicuspid AS using a new-generation device was feasible and effective with favorable valve performance and no cases of moderate or severe AR.

KEYWORDS:

aortic stenosis; bicuspid; transcatheter aortic valve replacement

PMID:
27101906
DOI:
10.1016/j.jcin.2016.01.002
[Indexed for MEDLINE]
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