Outcomes in Transcatheter Aortic Valve Replacement for Bicuspid Versus Tricuspid Aortic Valve Stenosis

Sung Han Yoon, Sabine Bleiziffer, Ole De Backer, Victoria Delgado, Takahide Arai, Johannes Ziegelmueller, Marco Barbanti, Rahul Sharma, Gidon Y. Perlman, Omar K. Khalique, Erik W. Holy, Smriti Saraf, Florian Deuschl, Buntaro Fujita, Philipp Ruile, Franz Josef Neumann, Gregor Pache, Masao Takahashi, Hidehiro Kaneko, Tobias SchmidtYohei Ohno, Niklas Schofer, William K.F. Kong, Edgar Tay, Daisuke Sugiyama, Hiroyuki Kawamori, Yoshio Maeno, Yigal Abramowitz, Tarun Chakravarty, Mamoo Nakamura, Shingo Kuwata, Gerald Yong, Hsien Li Kao, Michael Lee, Hyo Soo Kim, Thomas Modine, S. Chiu Wong, Francesco Bedgoni, Luca Testa, Emmanuel Teiger, Christian Butter, Stephan M. Ensminger, Ulrich Schaefer, Danny Dvir, Philipp Blanke, Jonathon Leipsic, Fabian Nietlispach, Mohamed Abdel-Wahab, Bernard Chevalier, Corrado Tamburino, David Hildick-Smith, Brian K. Whisenant, Seung Jung Park, Antonio Colombo, Azeem Latib, Susheel K. Kodali, Jeroen J. Bax, Lars Søndergaard, John G. Webb, Thierry Lefèvre, Martin B. Leon, Raj Makkar

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Abstract

Background Transcatheter aortic valve replacement (TAVR) is being increasingly performed in patients with bicuspid aortic valve stenosis (AS). Objectives This study sought to compare the procedural and clinical outcomes in patients with bicuspid versus tricuspid AS from the Bicuspid AS TAVR multicenter registry. Methods Outcomes of 561 patients with bicuspid AS and 4,546 patients with tricuspid AS were compared after propensity score matching, assembling 546 pairs of patients with similar baseline characteristics. Procedural and clinical outcomes were recorded according to Valve Academic Research Consortium-2 criteria. Results Compared with patients with tricuspid AS, patients with bicuspid AS had more frequent conversion to surgery (2.0% vs. 0.2%; p = 0.006) and a significantly lower device success rate (85.3% vs. 91.4%; p = 0.002). Early-generation devices were implanted in 320 patients with bicuspid and 321 patients with tricuspid AS, whereas new-generation devices were implanted in 226 and 225 patients with bicuspid and tricuspid AS, respectively. Within the group receiving early-generation devices, bicuspid AS had more frequent aortic root injury (4.5% vs. 0.0%; p = 0.015) when receiving the balloon-expanding device, and moderate-to-severe paravalvular leak (19.4% vs. 10.5%; p = 0.02) when receiving the self-expanding device. Among patients with new-generation devices, however, procedural results were comparable across different prostheses. The cumulative all-cause mortality rates at 2 years were comparable between bicuspid and tricuspid AS (17.2% vs. 19.4%; p = 0.28). Conclusions Compared with tricuspid AS, TAVR in bicuspid AS was associated with a similar prognosis, but lower device success rate. Procedural differences were observed in patients treated with the early-generation devices, whereas no differences were observed with the new-generation devices.

Original languageEnglish
Pages (from-to)2579-2589
Number of pages11
JournalJournal of the American College of Cardiology
Volume69
Issue number21
DOIs
Publication statusPublished - 2017 May 30

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Keywords

  • aortic stenosis
  • bicuspid aortic valve
  • transcatheter aortic valve implantation

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Yoon, S. H., Bleiziffer, S., De Backer, O., Delgado, V., Arai, T., Ziegelmueller, J., Barbanti, M., Sharma, R., Perlman, G. Y., Khalique, O. K., Holy, E. W., Saraf, S., Deuschl, F., Fujita, B., Ruile, P., Neumann, F. J., Pache, G., Takahashi, M., Kaneko, H., ... Makkar, R. (2017). Outcomes in Transcatheter Aortic Valve Replacement for Bicuspid Versus Tricuspid Aortic Valve Stenosis. Journal of the American College of Cardiology, 69(21), 2579-2589. https://doi.org/10.1016/j.jacc.2017.03.017