TY - JOUR
T1 - A Bicuspid Aortic Valve Imaging Classification for the TAVR Era
AU - Jilaihawi, Hasan
AU - Chen, Mao
AU - Webb, John
AU - Himbert, Dominique
AU - Ruiz, Carlos E.
AU - Rodés-Cabau, Josep
AU - Pache, Gregor
AU - Colombo, Antonio
AU - Nickenig, Georg
AU - Lee, Michael
AU - Tamburino, Corrado
AU - Sievert, Horst
AU - Abramowitz, Yigal
AU - Tarantini, Giuseppe
AU - Alqoofi, Faisal
AU - Chakravarty, Tarun
AU - Kashif, Mohammad
AU - Takahashi, Nobuyuki
AU - Kazuno, Yoshio
AU - Maeno, Yoshio
AU - Kawamori, Hiroyuki
AU - Chieffo, Alaide
AU - Blanke, Philipp
AU - Dvir, Danny
AU - Ribeiro, Henrique Barbosa
AU - Feng, Yuan
AU - Zhao, Zhen Gang
AU - Sinning, Jan Malte
AU - Kliger, Chad
AU - Giustino, Gennaro
AU - Pajerski, Basia
AU - Imme, Sebastiano
AU - Grube, Eberhard
AU - Leipsic, Jonathon
AU - Vahanian, Alec
AU - Michev, Iassen
AU - Jelnin, Vladimir
AU - Latib, Azeem
AU - Cheng, Wen
AU - Makkar, Raj
N1 - Publisher Copyright:
© 2016 American College of Cardiology Foundation
PY - 2016/10/1
Y1 - 2016/10/1
N2 - 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.
AB - 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.
KW - TAVI
KW - TAVR
KW - aortic stenosis
KW - aortic valve replacement
KW - bicuspid aortic valve
KW - transcatheter aortic valve implantation
KW - transcatheter aortic valve replacement
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U2 - 10.1016/j.jcmg.2015.12.022
DO - 10.1016/j.jcmg.2015.12.022
M3 - Article
C2 - 27372022
AN - SCOPUS:84978468509
SN - 1936-878X
VL - 9
SP - 1145
EP - 1158
JO - JACC: Cardiovascular Imaging
JF - JACC: Cardiovascular Imaging
IS - 10
ER -