Transcatheter Aortic Valve Implantation for Patients with Bicuspid Aortic Valves. Still a contraindication?
Mirko Doss, Thomas Walther.
Kerckhoff Heart Center, Bad Nauheim, Germany.
OBJECTIVE: The aim of this study was to evaluate the safety of transcatheter aortic valve implantation (TAVR) in patients with bicuspid aortic valves (BAV). METHODS:82 consecutive patients with stenotic BAV were treated with self-expanding (Core Valve, Symetis) and balloon expandable (Sapien 3, XT) transcatheter aortic valve prostheses, at our institution, from 2011 to 2014. Clinical outcomes were compared to a cohort of patients with tricuspid aortic stenosis (n=891) that received TAVR within the same time frame. Clinical endpoints were procedural complications, device success (VARC II) and 30 day all cause mortality.
RESULTS: The groups were comparable with regards to pre-operative data: mean age (81.8±6.2 years), logistic Euroscore (24.2±12.6%), STS score (6.4±4.2%), mean aortic gradient (44±16.8mmHg) and effective orifice area (0.7±0.2cm²). 30 day mortality was lower in the BAV group (2% vs 8.4%, p=0.12). Device success rate was lower in patients with BAV (73.1% vs 87.1%, p=0.004). Procedural complications were higher in the BAV group with regards to: residual aortic regurgitation > grade II (21.2% vs 7.8%, p=0.001), non-perpendicular deployment (30.2% vs 16.3%, p=0.002), malposition of the prosthesis (10.4% vs 3.5%, p=0.02) and the need for secondary valve in valve procedure (7.7% vs2.9%, p=0.05). The incidence of annular rupture (1.9% vs 0.5%) and conversion to open surgery (3.9% vs 2.5%) was comparable between the groups.
CONCLUSIONS: Treatment of BAV with TAVR bears significant procedural challenges. Although, 30 day mortality and valve function were similar to that of tricuspid aortic valves, BAV had significantly higher rates of procedural complications.
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