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JACC Cardiovasc Imaging. 2016 Oct;9(10):1145-1158. doi: 10.1016/j.jcmg.2015.12.022. Epub 2016 Jun 29.

A Bicuspid Aortic Valve Imaging Classification for the TAVR Era.

Author information

1
Department of Cardiology and Cardiothoracic Surgery, NYU Langone Medical Center, New York, New York. Electronic address: hasanjilaihawi@gmail.com.
2
Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China.
3
St. Paul's Hospital, Vancouver, Canada.
4
Department of Cardiology, Assistance Publique-Hôpitaux de Paris, Bichat-Claude Bernard Hospital, Paris, France.
5
Lenox Hill Heart and Vascular Institute of New York, New York, New York.
6
Quebec Heart and Lung Institute, Laval University, Quebec City, Canada.
7
University Hospital Freiburg, Freiburg, Germany.
8
EMO-GVM Centro Cuore Columbus and San Raffaele Scientific Institute, Milan, Italy.
9
Department of Internal Medicine and Cardiology/Pneumology, University of Bonn, Bonn, Germany.
10
Division of Cardiology, Department of Medicine, Queen Elizabeth Hospital, Kowloon, Hong Kong.
11
Ferrarotto Hospital, University of Catania, Catania, Italy.
12
Department of Cardiology and Vascular Medicine, CardioVasculäres Centrum Frankfurt, Frankfurt, Germany.
13
Cedars-Sinai Heart Institute, Los Angeles, California.
14
University of Padua, Padua, Italy.
15
University of Calgary, Calgary, Canada.
16
St. Paul's Hospital, Vancouver, Canada; University Hospital Freiburg, Freiburg, Germany.

Abstract

OBJECTIVES:

This study sought to evaluate transcatheter aortic valve replacement (TAVR) in bicuspid aortic valve (BAV) aortic stenosis (AS), with a particular emphasis on TAVR-directed bicuspid aortic valve imaging (BAVi) of morphological classification.

BACKGROUND:

TAVR has been used to treat BAV-AS but with heterogeneous outcomes and uncertainty regarding the relevance of morphology.

METHODS:

In 14 centers in the United States, Canada, Europe, and Asia, 130 BAV-AS patients underwent TAVR. Baseline cardiac computed tomography (CT) was analyzed by a dedicated Corelab. Outcomes were assessed in line with Valve Academic Research Consortium criteria.

RESULTS:

Bicommissural BAV (vs. tricommissural) accounted for 68.9% of those treated in North America, 88.9% in Europe, and 95.5% in Asia (p = 0.003). For bicommissural bicuspids, non-raphe type (vs. raphe type) BAV accounted for 11.9% of those treated in North America, 9.4% in Europe, and 61.9% in Asia (p < 0.001). Overall rates of 30-day mortality (3.8%) and cerebrovascular events (3.2%) were favorable and similar among anatomical subsets. The rate of new permanent pacemaker insertion was high (26.2%) and similar between balloon-expandable (BE) and self-expanding (SE) designs (BE: 25.5% vs. SE: 26.9%; p = 0.83); there was a trend to greater permanent pacemaker insertion in BE TAVR in the presence of coronary cusp fusion BAV morphology. Paravalvular aortic regurgitation (PAR) ≥ moderate was 18.1% overall but lower at 11.5% in those with pre-procedural CT. In the absence of pre-procedural CT, there was an excess of PAR in BE TAVR that was not the case in those with a pre-procedural CT; SE TAVR required more post-dilation. Predictors of PAR included intercommissural distance for bicommissural bicuspids (odd ratio [OR]: 1.37; 95% confidence interval [CI]: 1.02 to 1.84; p = 0.036) and lack of a baseline CT for annular measurement (OR: 3.03; 95% CI: 1.20 to 7.69; p = 0.018).

CONCLUSIONS:

In this multicenter study, TAVR achieved favorable outcomes in patients with pre-procedural CT, with the exception of high permanent pacemaker rates for all devices and shapes.

KEYWORDS:

TAVI; TAVR; aortic stenosis; aortic valve replacement; bicuspid aortic valve; transcatheter aortic valve implantation; transcatheter aortic valve replacement

Comment in

PMID:
27372022
DOI:
10.1016/j.jcmg.2015.12.022
[Indexed for MEDLINE]
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