Journal article
Bicuspid Aortic Valve Morphology and Outcomes After Transcatheter Aortic Valve Replacement.
- Yoon SH Cedars-Sinai Medical Center, Smidt Cedars-Sinai Heart Institute, Los Angeles, California.
- Kim WK Kerckhoff Heart and Thorax Center, Bad Nauheim, Germany.
- Dhoble A University of Texas Health Science Center, Houston, Texas.
- Milhorini Pio S Leiden University Medical Center, Leiden, the Netherlands.
- Babaliaros V Emory University School of Medicine, Atlanta, Georgia.
- Jilaihawi H Department of Cardiology and Cardiothoracic Surgery, NYU Langone Medical Center, New York, New York.
- Pilgrim T Bern University Hospital, Bern, Switzerland.
- De Backer O Heart Center, Rigshospitalet, Copenhagen, Denmark.
- Bleiziffer S Heart and Diabetes Center North Rhine-Westphalia, Bad Oeynhausen, Germany.
- Vincent F Department of Interventional Cardiology for Coronary, Valves and Structural Heart Diseases, CHU Lille Institut Cśur Poumon, Cardiology, Inserm U1011, Lille, France.
- Shmidt T Asklepios Klink St. Georg, Hamburg, Germany.
- Butter C Heart Center Brandenburg in Bernau & Brandenburg Medical School, Bernau, Germany.
- Kamioka N Emory University School of Medicine, Atlanta, Georgia.
- Eschenbach L German Heart Center Munich, Munich, Germany.
- Renker M Kerckhoff Heart and Thorax Center, Bad Nauheim, Germany.
- Asami M Bern University Hospital, Bern, Switzerland.
- Lazkani M University of Colorado Health, Loveland, Colorado.
- Fujita B Ruhr University Bochum, Bad Oeynhausen, Germany; Department of Cardiac and Thoracic Vascular Surgery, University of Schleswig-Holstein, Lübeck Campus, Lübeck, Germany.
- Birs A University of Washington, Seattle, Washington.
- Barbanti M University of Catania, Catania, Italy.
- Pershad A Banner University Medical Center, Phoenix, Arizona.
- Landes U Cardiology Department, Rabin Medical Center, Petah Tikva and Tel-Aviv University, Tel-Aviv, Israel.
- Oldemeyer B University of Colorado Health, Loveland, Colorado.
- Kitamura M Asklepios Klink St. Georg, Hamburg, Germany.
- Oakley L Cedars-Sinai Medical Center, Smidt Cedars-Sinai Heart Institute, Los Angeles, California.
- Ochiai T Cedars-Sinai Medical Center, Smidt Cedars-Sinai Heart Institute, Los Angeles, California.
- Chakravarty T Cedars-Sinai Medical Center, Smidt Cedars-Sinai Heart Institute, Los Angeles, California.
- Nakamura M Cedars-Sinai Medical Center, Smidt Cedars-Sinai Heart Institute, Los Angeles, California.
- Ruile P Department of Cardiology Angiology II, University Heart Center Freiburg-Bad Krozingen, Bad Krozingen, Germany.
- Deuschl F Structural Heart Division, University Heart Center, Hamburg, Hamburg, Germany.
- Berman D Cedars-Sinai Medical Center, Smidt Cedars-Sinai Heart Institute, Los Angeles, California.
- Modine T Department of Interventional Cardiology for Coronary, Valves and Structural Heart Diseases, CHU Lille Institut Cśur Poumon, Cardiology, Inserm U1011, Lille, France; Bordeaux University Hospital, Bordeaux, France.
- Ensminger S Ruhr University Bochum, Bad Oeynhausen, Germany; Department of Cardiac and Thoracic Vascular Surgery, University of Schleswig-Holstein, Lübeck Campus, Lübeck, Germany.
- Kornowski R Cardiology Department, Rabin Medical Center, Petah Tikva and Tel-Aviv University, Tel-Aviv, Israel.
- Lange R German Heart Center Munich, Munich, Germany.
- McCabe JM University of Washington, Seattle, Washington.
- Williams MR Department of Cardiology and Cardiothoracic Surgery, NYU Langone Medical Center, New York, New York.
- Whisenant B Intermountain Heart Institute, Salt Lake City, Utah.
- Delgado V Leiden University Medical Center, Leiden, the Netherlands.
- Windecker S Bern University Hospital, Bern, Switzerland.
- Van Belle E Department of Interventional Cardiology for Coronary, Valves and Structural Heart Diseases, CHU Lille Institut Cśur Poumon, Cardiology, Inserm U1011, Lille, France.
- Sondergaard L Heart Center, Rigshospitalet, Copenhagen, Denmark.
- Chevalier B Ramsay Generale de Sante Institute Cardiovasculaire Paris-Sud, Massy, France.
- Mack M Baylor Scott and White Health Heart Hospital-Plano, Plano, Texas.
- Bax JJ Leiden University Medical Center, Leiden, the Netherlands.
- Leon MB Columbia University Medical Center-New York Presbyterian Hospital, New York, New York.
- Makkar RR Cedars-Sinai Medical Center, Smidt Cedars-Sinai Heart Institute, Los Angeles, California. Electronic address: makkarr@cshs.org.
- 2020-08-29
Published in:
- Journal of the American College of Cardiology. - 2020
English
BACKGROUND
Bicuspid aortic stenosis accounts for almost 50% of patients undergoing surgical aortic valve replacement in the younger patients. Expanding the indication of transcatheter aortic valve replacement (TAVR) toward lower-risk and younger populations will lead to increased use of TAVR for patients with bicuspid aortic valve (BAV) stenosis despite the exclusion of bicuspid anatomy in all pivotal clinical trials.
OBJECTIVES
This study sought to evaluate the association of BAV morphology and outcomes of TAVR with the new-generation devices.
METHODS
Patients with BAV confirmed by central core laboratory computed tomography (CT) analysis were included from the international multicenter BAV TAVR registry. BAV morphology including the number of raphe, calcification grade in raphe, and leaflet calcium volume were assessed with CT analysis in a masked fashion. Primary outcomes were all-cause mortality at 1 and 2 years, and secondary outcomes included 30-day major endpoints and procedural complications.
RESULTS
A total of 1,034 CT-confirmed BAV patients with a mean age of 74.7 years and Society of Thoracic Surgeons score of 3.7% underwent TAVR with contemporary devices (n = 740 with Sapien 3; n = 188 with Evolut R/Pro; n = 106 with others). All-cause 30-day, 1-year, and 2-year mortality was 2.0%, 6.7%, and 12.5%, respectively. Multivariable analysis identified calcified raphe and excess leaflet calcification (defined as more than median calcium volume) as independent predictors of 2-year all-cause mortality. Both calcified raphe plus excess leaflet calcification were found in 269 patients (26.0%), and they had significantly higher 2-year all-cause mortality than those with 1 or none of these morphological features (25.7% vs. 9.5% vs. 5.9%; log-rank p < 0.001). Patients with both morphological features had higher rates of aortic root injury (p < 0.001), moderate-to-severe paravalvular regurgitation (p = 0.002), and 30-day mortality (p = 0.016).
CONCLUSIONS
Outcomes of TAVR in bicuspid aortic stenosis depend on valve morphology. Calcified raphe and excess leaflet calcification were associated with increased risk of procedural complications and midterm mortality. (Bicuspid Aortic Valve Stenosis Transcatheter Aortic Valve Replacement Registry; NCT03836521).
Bicuspid aortic stenosis accounts for almost 50% of patients undergoing surgical aortic valve replacement in the younger patients. Expanding the indication of transcatheter aortic valve replacement (TAVR) toward lower-risk and younger populations will lead to increased use of TAVR for patients with bicuspid aortic valve (BAV) stenosis despite the exclusion of bicuspid anatomy in all pivotal clinical trials.
OBJECTIVES
This study sought to evaluate the association of BAV morphology and outcomes of TAVR with the new-generation devices.
METHODS
Patients with BAV confirmed by central core laboratory computed tomography (CT) analysis were included from the international multicenter BAV TAVR registry. BAV morphology including the number of raphe, calcification grade in raphe, and leaflet calcium volume were assessed with CT analysis in a masked fashion. Primary outcomes were all-cause mortality at 1 and 2 years, and secondary outcomes included 30-day major endpoints and procedural complications.
RESULTS
A total of 1,034 CT-confirmed BAV patients with a mean age of 74.7 years and Society of Thoracic Surgeons score of 3.7% underwent TAVR with contemporary devices (n = 740 with Sapien 3; n = 188 with Evolut R/Pro; n = 106 with others). All-cause 30-day, 1-year, and 2-year mortality was 2.0%, 6.7%, and 12.5%, respectively. Multivariable analysis identified calcified raphe and excess leaflet calcification (defined as more than median calcium volume) as independent predictors of 2-year all-cause mortality. Both calcified raphe plus excess leaflet calcification were found in 269 patients (26.0%), and they had significantly higher 2-year all-cause mortality than those with 1 or none of these morphological features (25.7% vs. 9.5% vs. 5.9%; log-rank p < 0.001). Patients with both morphological features had higher rates of aortic root injury (p < 0.001), moderate-to-severe paravalvular regurgitation (p = 0.002), and 30-day mortality (p = 0.016).
CONCLUSIONS
Outcomes of TAVR in bicuspid aortic stenosis depend on valve morphology. Calcified raphe and excess leaflet calcification were associated with increased risk of procedural complications and midterm mortality. (Bicuspid Aortic Valve Stenosis Transcatheter Aortic Valve Replacement Registry; NCT03836521).
- Language
-
- English
- Open access status
- closed
- Identifiers
-
- DOI 10.1016/j.jacc.2020.07.005
- PMID 32854836
- Persistent URL
- https://folia.unifr.ch/global/documents/111205
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