Comparison of efficacy and safety of transcatheter aortic valve replacement in aortic stenosis patients with bicuspid <b><i>versus</i></b> tricuspid aortic valves _West China Medical Journal

Authors：

XU Yuanning , LI Yijian , OU Yuanweixiang , WANG Zijie , LIAO Yanbiao , ZHAO Zhengang , WEI Xin , PENG Yong ,  FENG Yuan ,  CHEN Mao

Department of Cardiology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;

Corresponding author：

FENG Yuan, Email: fynotebook@hotmail.com; CHEN Mao, Email: hmaochen@vip.sina.com

Keywords：

Transcatheter aortic valve replacement; Severe aortic stenosis; Bicuspid aortic valve

DOI：

10.7507/1002-0179.201711144

Video：

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Objective To compare the efficacy and safety of transcatheter aortic valve replacement (TAVR) in aortic stenosis patients with bicuspid aortic valve (BAV) versus tricuspid aortic valve (TAV). Methods This retrospective study included 252 consecutive patients with severe and symptomatic aortic valve stenosis undergoing TAVR in West China Hospital form April 2012 to September 2017, in whom 4 patients were excluded because of valve failure after surgical aortic valve replacement. Results Of the 248 patients, 131 had BAV and 117 had TAV. Baseline characteristics were similar between the two groups, including age [(73.56±6.35) vs. (74.31±6.35) years, P=0.354], male proportion (51.9% vs. 63.2%, P=0.072). Society of Thoracic Surgeons score for BAV patients was lower than that for TAV patients [(7.56±4.01)% vs. (8.78±5.14)%, P=0.037]. Procedural success rate was high in both BAV and TAV groups (95.4% vs. 98.3%, P=0.359). There was no difference in 30-day all-cause mortality (6.1% vs. 2.6%, P=0.176) between the two groups; the aortic valve maximum velocity of valve hemodynamics after TAVR was similiar [(2.39±0.53) vs. (2.31±0.45) m/s, P=0.262] between the two groups. Conclusions Patients with BAV show similar procedural and clinical outcomes to patients with TAV. Therefore, TAVR appears to be a safe and effective procedure for patients with BAV as well as those with TAV.

Citation： XU Yuanning, LI Yijian, OU Yuanweixiang, WANG Zijie, LIAO Yanbiao, ZHAO Zhengang, WEI Xin, PENG Yong, FENG Yuan, CHEN Mao. Comparison of efficacy and safety of transcatheter aortic valve replacement in aortic stenosis patients with bicuspid versus tricuspid aortic valves . West China Medical Journal, 2018, 33(2): 195-200. doi: 10.7507/1002-0179.201711144 Copy

1.	Nishimura RA, Otto CM, Bonow RO, et al. 2014 AHA/ACC guideline for the management of patients with valvular heart disease: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol, 2014, 63(22): 2438-2488.
2.	Nkomo VT, Gardin JM, Skelton TN, et al. Burden of valvular heart diseases: a population-based study. Lancet, 2006, 368(9540): 1005-1011.
3.	Kelly TA, Rothbart RM, Cooper CM, et al. Comparison of outcome of asymptomatic to symptomatic patients older than 20 years of age with valvular aortic stenosis. Am J Cardiol, 1988, 61(1): 123-130.
4.	Iung B, Cachier A, Baron G, et al. Decision-making in elderly patients with severe aortic stenosis: why are so many denied surgery?. Eur Heart J, 2005, 26(24): 2714-2720.
5.	Cribier A, Eltchaninoff H, Bash A, et al. Percutaneous transcatheter implantation of an aortic valve prosthesis for calcific aortic stenosis: first human case description. Circulation, 2002, 106(24): 3006-3008.
6.	Falk V, Baumgartner H, Bax JJ, et al. Corrigendum to '2017 ESC/EACTS Guidelines for the management of valvular heart disease' [Eur J Cardiothorac Surg 2017;52:616-664]. Eur J Cardiothorac Surg, 2017, 52(4): 832.
7.	Otto CM, Kumbhani DJ, Alexander KP, et al. 2017 ACC Expert Consensus Decision Pathway for Transcatheter Aortic Valve Replacement in the Management of Adults with Aortic Stenosis: a report of the American College of Cardiology Task Force on Clinical Expert Consensus Documents. J Am Coll Cardiol, 2017, 69(10): 1313-1346.
8.	Roberts WC, Ko JM. Frequency by decades of unicuspid, bicuspid, and tricuspid aortic valves in adults having isolated aortic valve replacement for aortic stenosis, with or without associated aortic regurgitation. Circulation, 2005, 111(7): 920-925.
9.	Wijesinghe N, Ye J, Rodés-Cabau J, et al. Transcatheter aortic valve implantation in patients with bicuspid aortic valve stenosis. JACC Cardiovasc Interv, 2010, 3(11): 1122-1125.
10.	Zegdi R, Ciobotaru V, Noghin M, et al. Is it reasonable to treat all calcified stenotic aortic valves with a valved stent? Results from a human anatomic study in adults. J Am Coll Cardiol, 2008, 51(5): 579-584.
11.	Leon MB, Smith CR, Mack M, et al. Transcatheter aortic-valve implantation for aortic stenosis in patients who cannot undergo surgery. N Engl J Med, 2010, 363(17): 1597-1607.
12.	Smith CR, Leon MB, Mack MJ, et al. Transcatheter versus surgical aortic-valve replacement in high-risk patients. N Engl J Med, 2011, 364(23): 2187-2198.
13.	Sievers HH, Schmidtke C. A classification system for the bicuspid aortic valve from 304 surgical specimens. J Thorac Cardiovasc Surg, 2007, 133(5): 1226-1233.
14.	Himbert D, Pontnau F, Messika-Zeitoun D, et al. Feasibility and outcomes of transcatheter aortic valve implantation in high-risk patients with stenotic bicuspid aortic valves. Am J Cardiol, 2012, 110(6): 877-883.
15.	Hayashida K, Bouvier E, Lefèvre T, et al. Transcatheter aortic valve implantation for patients with severe bicuspid aortic valve stenosis. Circ Cardiovasc Interv, 2013, 6(3): 284-291.
16.	Bauer T, Linke A, Sievert H, et al. Comparison of the effectiveness of transcatheter aortic valve implantation in patients with stenotic bicuspid versus tricuspid aortic valves (from the German TAVI Registry). Am J Cardiol, 2014, 113(3): 518-521.
17.	Costopoulos C, Latib A, Maisano F, et al. Comparison of results of transcatheter aortic valve implantation in patients with severely stenotic bicuspid versus tricuspid or nonbicuspid valves. Am J Cardiol, 2014, 113(8): 1390-1393.
18.	Zhao ZG, Jilaihawi H, Feng Y, et al. Transcatheter aortic valve implantation in bicuspid anatomy. Nat Rev Cardiol, 2015, 12(2): 123-128.
19.	Yoon SH, Lefèvre T, Ahn JM, et al. Transcatheter aortic valve replacement with early- and new-generation devices in bicuspid aortic valve stenosis. J Am Coll Cardiol, 2016, 68(11): 1195-1205.
20.	Jilaihawi H, Wu Y, Yang Y, et al. Morphological characteristics of severe aortic stenosis in China: imaging corelab observations from the first Chinese transcatheter aortic valve trial. Catheter Cardiovasc Interv, 2015, 85(Suppl 1): 752-761.
21.	Basso C, Boschello M, Perrone C, et al. An echocardiographic survey of primary school children for bicuspid aortic valve. Am J Cardiol, 2004, 93(5): 661-663.
22.	Braverman AC, Güven H, Beardslee MA, et al. The bicuspid aortic valve. Curr Probl Cardiol, 2005, 30(9): 470-522.
23.	Mack MJ, Brennan JM, Brindis R, et al. Outcomes following transcatheter aortic valve replacement in the United States. JAMA, 2013, 310(19): 2069-2077.

1. Nishimura RA, Otto CM, Bonow RO, et al. 2014 AHA/ACC guideline for the management of patients with valvular heart disease: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol, 2014, 63(22): 2438-2488.
2. Nkomo VT, Gardin JM, Skelton TN, et al. Burden of valvular heart diseases: a population-based study. Lancet, 2006, 368(9540): 1005-1011.
3. Kelly TA, Rothbart RM, Cooper CM, et al. Comparison of outcome of asymptomatic to symptomatic patients older than 20 years of age with valvular aortic stenosis. Am J Cardiol, 1988, 61(1): 123-130.
4. Iung B, Cachier A, Baron G, et al. Decision-making in elderly patients with severe aortic stenosis: why are so many denied surgery?. Eur Heart J, 2005, 26(24): 2714-2720.
5. Cribier A, Eltchaninoff H, Bash A, et al. Percutaneous transcatheter implantation of an aortic valve prosthesis for calcific aortic stenosis: first human case description. Circulation, 2002, 106(24): 3006-3008.
6. Falk V, Baumgartner H, Bax JJ, et al. Corrigendum to '2017 ESC/EACTS Guidelines for the management of valvular heart disease' [Eur J Cardiothorac Surg 2017;52:616-664]. Eur J Cardiothorac Surg, 2017, 52(4): 832.
7. Otto CM, Kumbhani DJ, Alexander KP, et al. 2017 ACC Expert Consensus Decision Pathway for Transcatheter Aortic Valve Replacement in the Management of Adults with Aortic Stenosis: a report of the American College of Cardiology Task Force on Clinical Expert Consensus Documents. J Am Coll Cardiol, 2017, 69(10): 1313-1346.
8. Roberts WC, Ko JM. Frequency by decades of unicuspid, bicuspid, and tricuspid aortic valves in adults having isolated aortic valve replacement for aortic stenosis, with or without associated aortic regurgitation. Circulation, 2005, 111(7): 920-925.
9. Wijesinghe N, Ye J, Rodés-Cabau J, et al. Transcatheter aortic valve implantation in patients with bicuspid aortic valve stenosis. JACC Cardiovasc Interv, 2010, 3(11): 1122-1125.
10. Zegdi R, Ciobotaru V, Noghin M, et al. Is it reasonable to treat all calcified stenotic aortic valves with a valved stent? Results from a human anatomic study in adults. J Am Coll Cardiol, 2008, 51(5): 579-584.
11. Leon MB, Smith CR, Mack M, et al. Transcatheter aortic-valve implantation for aortic stenosis in patients who cannot undergo surgery. N Engl J Med, 2010, 363(17): 1597-1607.
12. Smith CR, Leon MB, Mack MJ, et al. Transcatheter versus surgical aortic-valve replacement in high-risk patients. N Engl J Med, 2011, 364(23): 2187-2198.
13. Sievers HH, Schmidtke C. A classification system for the bicuspid aortic valve from 304 surgical specimens. J Thorac Cardiovasc Surg, 2007, 133(5): 1226-1233.
14. Himbert D, Pontnau F, Messika-Zeitoun D, et al. Feasibility and outcomes of transcatheter aortic valve implantation in high-risk patients with stenotic bicuspid aortic valves. Am J Cardiol, 2012, 110(6): 877-883.
15. Hayashida K, Bouvier E, Lefèvre T, et al. Transcatheter aortic valve implantation for patients with severe bicuspid aortic valve stenosis. Circ Cardiovasc Interv, 2013, 6(3): 284-291.
16. Bauer T, Linke A, Sievert H, et al. Comparison of the effectiveness of transcatheter aortic valve implantation in patients with stenotic bicuspid versus tricuspid aortic valves (from the German TAVI Registry). Am J Cardiol, 2014, 113(3): 518-521.
17. Costopoulos C, Latib A, Maisano F, et al. Comparison of results of transcatheter aortic valve implantation in patients with severely stenotic bicuspid versus tricuspid or nonbicuspid valves. Am J Cardiol, 2014, 113(8): 1390-1393.
18. Zhao ZG, Jilaihawi H, Feng Y, et al. Transcatheter aortic valve implantation in bicuspid anatomy. Nat Rev Cardiol, 2015, 12(2): 123-128.
19. Yoon SH, Lefèvre T, Ahn JM, et al. Transcatheter aortic valve replacement with early- and new-generation devices in bicuspid aortic valve stenosis. J Am Coll Cardiol, 2016, 68(11): 1195-1205.
20. Jilaihawi H, Wu Y, Yang Y, et al. Morphological characteristics of severe aortic stenosis in China: imaging corelab observations from the first Chinese transcatheter aortic valve trial. Catheter Cardiovasc Interv, 2015, 85(Suppl 1): 752-761.
21. Basso C, Boschello M, Perrone C, et al. An echocardiographic survey of primary school children for bicuspid aortic valve. Am J Cardiol, 2004, 93(5): 661-663.
22. Braverman AC, Güven H, Beardslee MA, et al. The bicuspid aortic valve. Curr Probl Cardiol, 2005, 30(9): 470-522.
23. Mack MJ, Brennan JM, Brindis R, et al. Outcomes following transcatheter aortic valve replacement in the United States. JAMA, 2013, 310(19): 2069-2077.

West China Medical Journal

Comparison of efficacy and safety of transcatheter aortic valve replacement in aortic stenosis patients with bicuspid versus tricuspid aortic valves

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