TY - JOUR
T1 - Annular size and interaction with trans-catheter aortic valves for treatment of severe bicuspid aortic valve stenosis
T2 - Insights from the BEAT registry
AU - Moscarella, Elisabetta
AU - Mangieri, Antonio
AU - Giannini, Francesco
AU - Tchetchè, Didier
AU - Kim, Won Keun
AU - Sinning, Jan Malte
AU - Landes, Uri
AU - Kornowski, Ran
AU - De Backer, Ole
AU - Nickenig, Georg
AU - De Biase, Chiara
AU - Søndergaard, Lars
AU - De Marco, Federico
AU - Bedogni, Francesco
AU - Ancona, Marco
AU - Montorfano, Matteo
AU - Regazzoli, Damiano
AU - Stefanini, Giulio
AU - Toggweiler, Stefan
AU - Tamburino, Corrado
AU - Immè, Sebastiano
AU - Tarantini, Giuseppe
AU - Sievert, Horst
AU - Schäfer, Ulrich
AU - Kempfert, Jörg
AU - Wöehrle, Jochen
AU - Latib, Azeem
AU - Calabrò, Paolo
AU - Medda, Massimo
AU - Tespili, Maurizio
AU - Colombo, Antonio
AU - Ielasi, Alfonso
N1 - Publisher Copyright:
© 2021
PY - 2022/2/15
Y1 - 2022/2/15
N2 - Background: Transcatheter aortic valve replacement (TAVR) is safe and feasible in patients with bicuspid aortic valve (BAV), but whether annular size may influence TAVR results in BAV patients remains unclear. We aimed at evaluating the impact of aortic annular size on procedural and clinical outcomes of BAV patients undergoing TAVR, as well as potential interactions between annular dimension and trans-catheter heart valve (THV) type (balloon-expandable (BEV) vs. self-expanding (SEV). Methods: BEAT is a multicenter registry of consecutive BAV stenosis undergoing TAVR. For this sub-study patients were classified according to annular dimension in small-annulus (area < 400 mm2 or perimeter <72 mm), medium-annulus (area ≥ 400 and < 575 mm2, perimeter ≥72 mm and< 85 mm), large-annulus (area ≥ 575 mm2 or perimeter ≥85 mm). Primary endpoint was Valve Academic Research Consortium-2 (VARC-2) device success. Results: 45(15.5%) patients had small, 132(45.3%) medium, and 114(39.2%) large annuli. Compared with other groups, patients with large annuli were more frequently male, younger, with higher body mass index, larger aortic valve area, higher rate of moderate-severe calcification, lower mean trans-aortic valve gradient and lower left ventricular ejection fraction. In large-annuli SEVs were associated with a lower VARC-2 device success (75.9% vs. 90.6%, p = 0.049) driven by a higher rate of paravalvular valvular leak (PVL) compared to BEVs (20.7% vs. 1.2%, p < 0.001). However, no differences in clinical outcomes were observed according to annular size nor THV type. Conclusions: TAVR in BAV patients is feasible irrespective of annular size. However in patients with large aortic annulus SEVs were associated with a significantly higher rate of PVLs compared to BEVs.
AB - Background: Transcatheter aortic valve replacement (TAVR) is safe and feasible in patients with bicuspid aortic valve (BAV), but whether annular size may influence TAVR results in BAV patients remains unclear. We aimed at evaluating the impact of aortic annular size on procedural and clinical outcomes of BAV patients undergoing TAVR, as well as potential interactions between annular dimension and trans-catheter heart valve (THV) type (balloon-expandable (BEV) vs. self-expanding (SEV). Methods: BEAT is a multicenter registry of consecutive BAV stenosis undergoing TAVR. For this sub-study patients were classified according to annular dimension in small-annulus (area < 400 mm2 or perimeter <72 mm), medium-annulus (area ≥ 400 and < 575 mm2, perimeter ≥72 mm and< 85 mm), large-annulus (area ≥ 575 mm2 or perimeter ≥85 mm). Primary endpoint was Valve Academic Research Consortium-2 (VARC-2) device success. Results: 45(15.5%) patients had small, 132(45.3%) medium, and 114(39.2%) large annuli. Compared with other groups, patients with large annuli were more frequently male, younger, with higher body mass index, larger aortic valve area, higher rate of moderate-severe calcification, lower mean trans-aortic valve gradient and lower left ventricular ejection fraction. In large-annuli SEVs were associated with a lower VARC-2 device success (75.9% vs. 90.6%, p = 0.049) driven by a higher rate of paravalvular valvular leak (PVL) compared to BEVs (20.7% vs. 1.2%, p < 0.001). However, no differences in clinical outcomes were observed according to annular size nor THV type. Conclusions: TAVR in BAV patients is feasible irrespective of annular size. However in patients with large aortic annulus SEVs were associated with a significantly higher rate of PVLs compared to BEVs.
KW - Annulus dimensions
KW - Balloon expandable valves
KW - Bicuspid aortic valve
KW - Self-expanding valve
KW - Severe aortic stenosis
KW - Trans-catheter valve replacement
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U2 - 10.1016/j.ijcard.2021.11.055
DO - 10.1016/j.ijcard.2021.11.055
M3 - Article
C2 - 34843819
AN - SCOPUS:85122332147
SN - 0167-5273
VL - 349
SP - 31
EP - 38
JO - International Journal of Cardiology
JF - International Journal of Cardiology
ER -