Transcatheter aortic valve replacement for patients with severe bicuspid aortic stenosis

• Published in: The American heart journal 2020-06, Vol.224, p.105-112
• Main Authors: Pineda, Andrés M., Rymer, Jennifer, Wang, Alice, Banks, Adam Z., Koweek, Lynne H., Plichta, Ryan, Williams, Adam, Vavalle, John P., Halim, Sharif, Kiefer, Todd, Wang, Andrew, Gaca, Jeffrey, Hughes, G. Chad, Harrison, J. Kevin
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Aorta; Aortic stenosis; Aortic valve; Aortic Valve - abnormalities; Aortic Valve - surgery; Aortic Valve Stenosis - diagnosis; Aortic Valve Stenosis - surgery; Bicuspid Aortic Valve Disease; Body mass; Body mass index; Body size; Calcification; Cardiovascular disease; Chronic obstructive pulmonary disease; Clinical outcomes; Clinical trials; Coronary artery; Coronary artery disease; Electrocardiography; Female; Follow-Up Studies; Heart diseases; Heart surgery; Heart Valve Diseases - diagnosis; Heart Valve Diseases - surgery; Heart valves; Humans; Incidence; Lung diseases; Male; Mercury; Middle Aged; Morphology; Mortality; North Carolina - epidemiology; Obstructive lung disease; Patients; Postoperative Complications - epidemiology; Prostheses; Regurgitation; Retrospective Studies; Severity of Illness Index; Stenosis; Surgeons; Survival; Survival Rate - trends; Thorax; Tomography, X-Ray Computed; Transcatheter Aortic Valve Replacement - methods; Treatment Outcome; Ultrasonic imaging
• ISSN: 0002-8703; 1097-6744
• DOI: 10.1016/j.ahj.2020.02.003

Patients with bicuspid aortic valve stenosis (BAV) were excluded from all the trileaflet aortic valve stenosis (TAV) pivotal trials, and therefore, their outcomes are not clearly defined. The aim of the study was to evaluate the outcomes of transcatheter aortic valve replacement (TAVR) in patients with BAV and compared them with those of TAV. We evaluated the outcomes following TAVR of patients with BAV at our institution between April 2011 and November 2016 and compared them with the outcomes of patients with TAV treated with TAVR. The χ2 and the Mann-Whitney U tests were used to compare the groups, and a Kaplan-Meier analysis was performed to estimate long-term survival. TAVR was performed in a total of 567 patients, from which 50 (8.8%) had BAV and 517 (91.2%) had TAV. Patients with BAV were younger and had higher prevalence of chronic obstructive pulmonary disease, lower prevalence of coronary artery disease, higher body mass index, and lower Society of Thoracic Surgeons score (STS PROM). Patients with BAV had a slightly higher mean aortic valve gradient postoperatively (median 12 mm Hg [10-15] vs 10 [7-13], P  mild 4.0% vs 3.5%, P = .541). Clinical outcomes were not different between the groups, including stroke (2.0% vs 1.5, P = .567) and the 30-day all-cause mortality (6.0% vs 1.5, P = .064). The 2-year survival (82.0% vs 83.4, P = .476) was similar between the groups. This initial experience suggests that TAVR can be safely performed in patients with BAV, achieving similar short-term procedural and clinical outcomes when compared with patients with TAV.