Transcatheter aortic valve implantation for patients with severe bicuspid aortic valve stenosis

Kentaro Hayashida, Erik Bouvier, Thierry Lefèvre, Bernard Chevalier, Thomas Hovasse, Mauro Romano, Philippe Garot, Yusuke Watanabe, Arnaud Farge, Patrick Donzeau-Gouge, Bertrand Cormier, Marie Claude Morice

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Abstract

Background-Bicuspid aortic valve (BAV) is regarded as a relative contraindication to transcatheter aortic valve implantation attributable to the risk of uneven expansion of the bioprosthesis. The purpose of this study was to evaluate the efficacy and safety of transcatheter aortic valve implantation in patients with BAV. Methods and Results-Of 470 patients included in our prospective transcatheter aortic valve implantation database (October 2006-January 2012), 229 consecutive patients undergoing both echocardiography and multidetector computed tomography were analyzed. We compared clinical outcomes in patients with vs patients without BAV. In this series of 229 patients, BAV was detected by multidetector computed tomography in 21 patients (9.2%). BAV was identified by transthoracic and transoesophagal echocardiography in only 9 of these 21 patients. Patients were 83.1±6.6 years old, and European system for cardiac operative risk evaluation score was 20.0%±11.4%. The BAV group was similar to the non-BAV group except for diabetes mellitus (4.8% vs 24.0%; P=0.05). The aortic annulus diameter in BAV patients was not significantly larger by multidetector computed tomography (24.7±3.0 vs 23.7±1.9 mm; P=0.07). The CoreValve was used more frequently in the BAV group (47.6% vs 16.3%; P=0.002). There was no significant difference in device success (100% vs 92.8%; P=0.37), risk of annulus rupture (0% vs 1.4%; P=1.00), or valve migration (0% vs 1.4%; P=1.00) in BAV patients compared with non-BAV patients. Postprocedural mean gradient (10.0±3.4 vs 9.7±4.1 mm Hg; P=0.58), aortic regurgitation ≥2 of 4 (19.0% vs 14.9%; P=0.54), 30-day mortality (4.8% vs 8.2%; P=1.00), and 30-day combined safety end point (14.3% vs 13.5%; P=1.00) were also similar in both groups. Conclusions-In selected BAV patients, transcatheter aortic valve implantation may be associated with low complication rate, efficacy, and acceptable outcomes similar to those in non-BAV patients.

Original languageEnglish
Pages (from-to)284-291
Number of pages8
JournalCirculation: Cardiovascular Interventions
Volume6
Issue number3
DOIs
Publication statusPublished - 2013 Jun 1

Keywords

  • Aortic stenosis
  • Bicuspid aortic valve
  • Computed tomography
  • Echocardiography
  • Transcatheter aortic valve implantation

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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    Hayashida, K., Bouvier, E., Lefèvre, T., Chevalier, B., Hovasse, T., Romano, M., Garot, P., Watanabe, Y., Farge, A., Donzeau-Gouge, P., Cormier, B., & Morice, M. C. (2013). Transcatheter aortic valve implantation for patients with severe bicuspid aortic valve stenosis. Circulation: Cardiovascular Interventions, 6(3), 284-291. https://doi.org/10.1161/CIRCINTERVENTIONS.112.000084