Predictors of high residual gradient after transcatheter aortic valve replacement in bicuspid aortic valve stenosis

Giulia Bugani; Matteo Pagnesi; Didier Tchetchè; Won Keun Kim; Arif Khokhar; Jean Malte Sinning; Uri Landes; Ran Kornowski; Pablo Codner; Ole De Backer; Georg Nickenig; Alfonso Ielasi; Chiara De Biase; Lars Søndergaard; Federico De Marco; Marco Ancona; Matteo Montorfano; Damiano Regazzoli; Giulio Stefanini; Stefan Toggweiler; Corrado Tamburino; Sebastiano Immè; Giuseppe Tarantini; Horst Sievert; Ulrich Schäfer; Jörg Kempfert; Jochen Wöehrle; Maurizio Tespili; Alessandra Laricchia; Azeem Latib; Francesco Giannini; Antonio Colombo; Antonio Mangieri

doi:10.1007/s00392-020-01793-9

Predictors of high residual gradient after transcatheter aortic valve replacement in bicuspid aortic valve stenosis

Giulia Bugani, Matteo Pagnesi, Didier Tchetchè, Won Keun Kim, Arif Khokhar, Jean Malte Sinning, Uri Landes, Ran Kornowski, Pablo Codner, Ole De Backer, Georg Nickenig, Alfonso Ielasi, Chiara De Biase, Lars Søndergaard, Federico De Marco, Marco Ancona, Matteo Montorfano, Damiano Regazzoli, Giulio Stefanini, Stefan ToggweilerCorrado Tamburino, Sebastiano Immè, Giuseppe Tarantini, Horst Sievert, Ulrich Schäfer, Jörg Kempfert, Jochen Wöehrle, Maurizio Tespili, Alessandra Laricchia, Azeem Latib, Francesco Giannini, Antonio Colombo, Antonio Mangieri

Medicine

Research output: Contribution to journal › Article › peer-review

8 Scopus citations

Abstract

Objectives: To define the incidence of high residual gradient (HRG) after transcatheter aortic valve replacement (TAVR) in BAVs and their impact on short term outcome and 1-year mortality. Background: Transcatheter heart valves (THVs) offer good performance in tricuspid aortic valves with low rate of HRG. However, data regarding their performance in bicuspid aortic valves (BAV) are still lacking. Methods: The BEAT (Balloon vs Self-Expandable valve for the treatment of bicuspid Aortic valve sTenosis) registry included 353 consecutive patients who underwent TAVR (Evolut R/PRO or Sapien 3 valves) in BAV between June 2013 and October 2018. The primary endpoint was device unsuccess with post-procedural HRG (mean gradient ≥ 20 mmHg). The secondary endpoint was to identify the predictors of HRG following the procedure. Results: Twenty patients (5.6%) showed HRG after TAVR. Patients with HRG presented higher body mass index (BMI) (30.7 ± 9.3 vs. 25.9 ± 4.8; p < 0.0001) and higher baseline aortic mean gradients (57.6 ± 13.4 mmHg vs. 47.7 ± 16.6, p = 0.013) and more often presented with BAV of Sievers type 0 than patients without HRG. At multivariate analysis, BMI [odds ratio (OR) 1.12; 95% confidence interval (CI) 1.05–1.20, p = 0.001] and BAV type 0 (OR 11.31, 95% CI 3.45–37.06, p < 0.0001) were confirmed as independent predictors of high gradient. Conclusion: HRG following TAVR in BAVs is not negligible and is higher among patients with high BMI and with BAV 0 anatomy. Graphic abstract: [Figure not available: see fulltext.].

Original language	English (US)
Pages (from-to)	667-675
Number of pages	9
Journal	Clinical Research in Cardiology
Volume	110
Issue number	5
DOIs	https://doi.org/10.1007/s00392-020-01793-9
State	Published - May 2021

Keywords

Balloon-expandable valve
Bicuspid
High residual gradient
Self-expandable valve
Transcatheter aortic valve implantation

ASJC Scopus subject areas

Cardiology and Cardiovascular Medicine

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10.1007/s00392-020-01793-9

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Bugani, G., Pagnesi, M., Tchetchè, D., Kim, W. K., Khokhar, A., Sinning, J. M., Landes, U., Kornowski, R., Codner, P., De Backer, O., Nickenig, G., Ielasi, A., De Biase, C., Søndergaard, L., De Marco, F., Ancona, M., Montorfano, M., Regazzoli, D., Stefanini, G., ... Mangieri, A. (2021). Predictors of high residual gradient after transcatheter aortic valve replacement in bicuspid aortic valve stenosis. Clinical Research in Cardiology, 110(5), 667-675. https://doi.org/10.1007/s00392-020-01793-9

Bugani, G, Pagnesi, M, Tchetchè, D, Kim, WK, Khokhar, A, Sinning, JM, Landes, U, Kornowski, R, Codner, P, De Backer, O, Nickenig, G, Ielasi, A, De Biase, C, Søndergaard, L, De Marco, F, Ancona, M, Montorfano, M, Regazzoli, D, Stefanini, G, Toggweiler, S, Tamburino, C, Immè, S, Tarantini, G, Sievert, H, Schäfer, U, Kempfert, J, Wöehrle, J, Tespili, M, Laricchia, A, Latib, A, Giannini, F, Colombo, A & Mangieri, A 2021, 'Predictors of high residual gradient after transcatheter aortic valve replacement in bicuspid aortic valve stenosis', Clinical Research in Cardiology, vol. 110, no. 5, pp. 667-675. https://doi.org/10.1007/s00392-020-01793-9

@article{7f567b7162b741e596df75a1b11dad42,

title = "Predictors of high residual gradient after transcatheter aortic valve replacement in bicuspid aortic valve stenosis",

abstract = "Objectives: To define the incidence of high residual gradient (HRG) after transcatheter aortic valve replacement (TAVR) in BAVs and their impact on short term outcome and 1-year mortality. Background: Transcatheter heart valves (THVs) offer good performance in tricuspid aortic valves with low rate of HRG. However, data regarding their performance in bicuspid aortic valves (BAV) are still lacking. Methods: The BEAT (Balloon vs Self-Expandable valve for the treatment of bicuspid Aortic valve sTenosis) registry included 353 consecutive patients who underwent TAVR (Evolut R/PRO or Sapien 3 valves) in BAV between June 2013 and October 2018. The primary endpoint was device unsuccess with post-procedural HRG (mean gradient ≥ 20 mmHg). The secondary endpoint was to identify the predictors of HRG following the procedure. Results: Twenty patients (5.6%) showed HRG after TAVR. Patients with HRG presented higher body mass index (BMI) (30.7 ± 9.3 vs. 25.9 ± 4.8; p < 0.0001) and higher baseline aortic mean gradients (57.6 ± 13.4 mmHg vs. 47.7 ± 16.6, p = 0.013) and more often presented with BAV of Sievers type 0 than patients without HRG. At multivariate analysis, BMI [odds ratio (OR) 1.12; 95% confidence interval (CI) 1.05–1.20, p = 0.001] and BAV type 0 (OR 11.31, 95% CI 3.45–37.06, p < 0.0001) were confirmed as independent predictors of high gradient. Conclusion: HRG following TAVR in BAVs is not negligible and is higher among patients with high BMI and with BAV 0 anatomy. Graphic abstract: [Figure not available: see fulltext.].",

keywords = "Balloon-expandable valve, Bicuspid, High residual gradient, Self-expandable valve, Transcatheter aortic valve implantation",

author = "Giulia Bugani and Matteo Pagnesi and Didier Tchetch{\`e} and Kim, {Won Keun} and Arif Khokhar and Sinning, {Jean Malte} and Uri Landes and Ran Kornowski and Pablo Codner and {De Backer}, Ole and Georg Nickenig and Alfonso Ielasi and {De Biase}, Chiara and Lars S{\o}ndergaard and {De Marco}, Federico and Marco Ancona and Matteo Montorfano and Damiano Regazzoli and Giulio Stefanini and Stefan Toggweiler and Corrado Tamburino and Sebastiano Imm{\`e} and Giuseppe Tarantini and Horst Sievert and Ulrich Sch{\"a}fer and J{\"o}rg Kempfert and Jochen W{\"o}ehrle and Maurizio Tespili and Alessandra Laricchia and Azeem Latib and Francesco Giannini and Antonio Colombo and Antonio Mangieri",

note = "Publisher Copyright: {\textcopyright} 2021, Springer-Verlag GmbH Germany, part of Springer Nature.",

year = "2021",

month = may,

doi = "10.1007/s00392-020-01793-9",

language = "English (US)",

volume = "110",

pages = "667--675",

journal = "Clinical Research in Cardiology",

issn = "1861-0684",

publisher = "D. Steinkopff-Verlag",

number = "5",

}

TY - JOUR

T1 - Predictors of high residual gradient after transcatheter aortic valve replacement in bicuspid aortic valve stenosis

AU - Bugani, Giulia

AU - Pagnesi, Matteo

AU - Tchetchè, Didier

AU - Kim, Won Keun

AU - Khokhar, Arif

AU - Sinning, Jean Malte

AU - Landes, Uri

AU - Kornowski, Ran

AU - Codner, Pablo

AU - De Backer, Ole

AU - Nickenig, Georg

AU - Ielasi, Alfonso

AU - De Biase, Chiara

AU - Søndergaard, Lars

AU - De Marco, Federico

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 - Tespili, Maurizio

AU - Laricchia, Alessandra

AU - Latib, Azeem

AU - Giannini, Francesco

AU - Colombo, Antonio

AU - Mangieri, Antonio

PY - 2021/5

Y1 - 2021/5

N2 - Objectives: To define the incidence of high residual gradient (HRG) after transcatheter aortic valve replacement (TAVR) in BAVs and their impact on short term outcome and 1-year mortality. Background: Transcatheter heart valves (THVs) offer good performance in tricuspid aortic valves with low rate of HRG. However, data regarding their performance in bicuspid aortic valves (BAV) are still lacking. Methods: The BEAT (Balloon vs Self-Expandable valve for the treatment of bicuspid Aortic valve sTenosis) registry included 353 consecutive patients who underwent TAVR (Evolut R/PRO or Sapien 3 valves) in BAV between June 2013 and October 2018. The primary endpoint was device unsuccess with post-procedural HRG (mean gradient ≥ 20 mmHg). The secondary endpoint was to identify the predictors of HRG following the procedure. Results: Twenty patients (5.6%) showed HRG after TAVR. Patients with HRG presented higher body mass index (BMI) (30.7 ± 9.3 vs. 25.9 ± 4.8; p < 0.0001) and higher baseline aortic mean gradients (57.6 ± 13.4 mmHg vs. 47.7 ± 16.6, p = 0.013) and more often presented with BAV of Sievers type 0 than patients without HRG. At multivariate analysis, BMI [odds ratio (OR) 1.12; 95% confidence interval (CI) 1.05–1.20, p = 0.001] and BAV type 0 (OR 11.31, 95% CI 3.45–37.06, p < 0.0001) were confirmed as independent predictors of high gradient. Conclusion: HRG following TAVR in BAVs is not negligible and is higher among patients with high BMI and with BAV 0 anatomy. Graphic abstract: [Figure not available: see fulltext.].

AB - Objectives: To define the incidence of high residual gradient (HRG) after transcatheter aortic valve replacement (TAVR) in BAVs and their impact on short term outcome and 1-year mortality. Background: Transcatheter heart valves (THVs) offer good performance in tricuspid aortic valves with low rate of HRG. However, data regarding their performance in bicuspid aortic valves (BAV) are still lacking. Methods: The BEAT (Balloon vs Self-Expandable valve for the treatment of bicuspid Aortic valve sTenosis) registry included 353 consecutive patients who underwent TAVR (Evolut R/PRO or Sapien 3 valves) in BAV between June 2013 and October 2018. The primary endpoint was device unsuccess with post-procedural HRG (mean gradient ≥ 20 mmHg). The secondary endpoint was to identify the predictors of HRG following the procedure. Results: Twenty patients (5.6%) showed HRG after TAVR. Patients with HRG presented higher body mass index (BMI) (30.7 ± 9.3 vs. 25.9 ± 4.8; p < 0.0001) and higher baseline aortic mean gradients (57.6 ± 13.4 mmHg vs. 47.7 ± 16.6, p = 0.013) and more often presented with BAV of Sievers type 0 than patients without HRG. At multivariate analysis, BMI [odds ratio (OR) 1.12; 95% confidence interval (CI) 1.05–1.20, p = 0.001] and BAV type 0 (OR 11.31, 95% CI 3.45–37.06, p < 0.0001) were confirmed as independent predictors of high gradient. Conclusion: HRG following TAVR in BAVs is not negligible and is higher among patients with high BMI and with BAV 0 anatomy. Graphic abstract: [Figure not available: see fulltext.].

KW - Balloon-expandable valve

KW - Bicuspid

KW - High residual gradient

KW - Self-expandable valve

KW - Transcatheter aortic valve implantation

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U2 - 10.1007/s00392-020-01793-9

DO - 10.1007/s00392-020-01793-9

M3 - Article

C2 - 33389062

AN - SCOPUS:85098541534

SN - 1861-0684

VL - 110

SP - 667

EP - 675

JO - Clinical Research in Cardiology

JF - Clinical Research in Cardiology

IS - 5

ER -

Predictors of high residual gradient after transcatheter aortic valve replacement in bicuspid aortic valve stenosis

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