1. A Bicuspid Aortic Valve Imaging Classification for the TAVR Era.
- Author
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Jilaihawi H, Chen M, Webb J, Himbert D, Ruiz CE, Rodés-Cabau J, Pache G, Colombo A, Nickenig G, Lee M, Tamburino C, Sievert H, Abramowitz Y, Tarantini G, Alqoofi F, Chakravarty T, Kashif M, Takahashi N, Kazuno Y, Maeno Y, Kawamori H, Chieffo A, Blanke P, Dvir D, Ribeiro HB, Feng Y, Zhao ZG, Sinning JM, Kliger C, Giustino G, Pajerski B, Imme S, Grube E, Leipsic J, Vahanian A, Michev I, Jelnin V, Latib A, Cheng W, and Makkar R
- Subjects
- Aged, Aged, 80 and over, Aortic Valve diagnostic imaging, Aortic Valve physiopathology, Aortic Valve surgery, Aortic Valve Stenosis classification, Aortic Valve Stenosis physiopathology, Asia, Bicuspid Aortic Valve Disease, Canada, Europe, Female, Heart Valve Diseases classification, Heart Valve Diseases physiopathology, Humans, Male, Predictive Value of Tests, Treatment Outcome, United States, Aortic Valve abnormalities, Aortic Valve Stenosis diagnostic imaging, Aortic Valve Stenosis surgery, Heart Valve Diseases diagnostic imaging, Heart Valve Diseases surgery, Multidetector Computed Tomography, Transcatheter Aortic Valve Replacement
- 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., (Copyright © 2016 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.)
- Published
- 2016
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