Comparing clinical outcomes between bicuspid and tricuspid aortic valve stenosis after transcatheter aortic valve replacement: A systematic review and meta-analysis_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

LIU Shidong ¹ , DONG Shuai ¹ , FANG Tao ¹ , LEI Xiang ¹ ,  SONG Bing ²

1. The First Clinical Medical College of Lanzhou University, Lanzhou, 730000, P.R.China;
2. Department of Cardiovascular Surgery, The First Hospital of Lanzhou University, Lanzhou, 730000, P.R.China;

Corresponding author：

SONG Bing, Email: songbing@163.com

Keywords：

Aortic valve stenosis; bicuspid aortic valve; transcatheter aortic valve replacement; systematic review/meta-analysis

DOI：

10.7507/1007-4848.201905005

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Objective To compare the clinical outcomes of bicuspid aortic valve stenosis (BAV) and tricuspid aortic valve stenosis (TAV) after transcatheter aortic valve replacement (TAVR).Methods A computer-based search in PubMed, EMbase, The Cochrane Library, CBM, CNKI and Wanfang databases from their date of inception to March 2019 was conducted. Two reviewers independently screened the articles, extracted data and evaluated their quality. RevMan 5.3 and Stata 15.0 softwares were used for meta-analysis.Results The selected 15 cohort studies contained 45 770 patients, including 1 500 of BAV patients and 44 270 of TAV patients. The results showed that no statistical difference was found in postoperative in-hospital mortality [OR=1.29, 95%CI (0.91, 1.83), P=0.15], 30-day mortality [OR=1.23, 95%CI (0.86, 1.77), P=0.25], and 1-year mortality [OR=1.14, 95%CI (0.87, 1.50), P=0.33] between the two groups. The surgical success rate [OR=0.57, 95%CI (0.44, 0.74), P<0.01], postoperative bleeding events [OR=0.72, 95%CI (0.58, 0.91), P<0.01] and postoperative vascular injury [OR=0.68, 95%CI (0.47, 0.97), P=0.03] of patients in the BAV group were lower than those in the TAV group. The incidence of paravalvular leak in the BAV group was higher than that in the TAV group [OR=1.47, 95%CI (1.13, 1.90), P<0.01]. No significant difference was found between the two groups in terms of conversion to surgery, postoperative myocardial infarction, postoperative renal failure, postoperative neurologic events, postoperative valve gradient difference and pacemaker implantation.Conclusion Compared with TAV, the application of TAVR in BAV patients is feasible and effective.

Citation： LIU Shidong, DONG Shuai, FANG Tao, LEI Xiang, SONG Bing. Comparing clinical outcomes between bicuspid and tricuspid aortic valve stenosis after transcatheter aortic valve replacement: A systematic review and meta-analysis. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2020, 27(6): 693-699. doi: 10.7507/1007-4848.201905005 Copy

1.	Siu SC, Silversides CK. Bicuspid aortic valve disease. J Am Coll Cardiol, 2010, 55(25): 2789-2800.
2.	Tadros TM, Klein MD, Shapira OM. Ascending aortic dilatation associated with bicuspid aortic valve: pathophysiology, molecular biology, and clinical implications. Circulation, 2009, 119(6): 880-890.
3.	Nistri S, Basso C, Marzari C, et al. Frequency of bicuspid aortic valve in young male conscripts by echocardiogram. Am J Cardiol, 2005, 96(5): 718-721.
4.	Michelena HI, Khanna AD, Mahoney D, et al. Incidence of aortic complications in patients with bicuspid aortic valves. JAMA, 2011, 306(10): 1104-1112.
5.	Fernandes SM, Khairy P, Sanders SP, et al. Bicuspid aortic valve morphology and interventions in the young. J Am Coll Cardiol, 2007, 49(22): 2211-2214.
6.	Nishimura RA, Otto CM, Bonow RO, et al. 2017 AHA/ACC focused update of the 2014 AHA/ACC guideline for the management of patients with valvular heart disease: A report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation, 2017, 135(25): e1159-e1195.
7.	Nishimura RA, Otto CM, Bonow RO, et al. 2014 AHA/ACC guideline for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation, 2014, 129(23): e521-e643.
8.	Colombo A, Latib A. Bicuspid aortic valve: any room for TAVR? J Am Coll Cardiol, 2014, 64(22): 2340-2342.
9.	Kodali SK, Williams MR, Smith CR, et al. Two-year outcomes after transcatheter or surgical aortic-valve replacement. N Engl J Med, 2012, 366(18): 1686-1695.
10.	Chen M, Feng Y, Mazzitelli D, et al. Transcatheter aortic valve implantation in a patient with severe bicuspid aortic valve stenosis and ascending aortic aneurysm. JACC Cardiovasc Interv, 2014, 7(7): e83-e84.
11.	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.
12.	Wijesinghe N, Ye J, Rodes-Cabau J, et al. Transcatheter aortic valve implantation in patients with bicuspid aortic valve stenosis. JACC Cardiovasc Interv, 2010, 3(11): 1122-5.
13.	Perlman GY, Blanke P, Dvir D, et al. Bicuspid aortic valve stenosis: favorable early outcomes with a next-generation transcatheter heart valve in a multicenter study. JACC Cardiovasc Interv, 2016, 9(8): 817-824.
14.	Jadad AR, Moore RA, Carroll D, et al. Assessing the quality of reports of randomized clinical trials: is blinding necessary? Control Clin Trials, 1996, 17(1): 1-12.
15.	Cota GF, de Sousa MR, Fereguetti TO, et al. Efficacy of anti-leishmania therapy in visceral leishmaniasis among HIV infected patients: a systematic review with indirect comparison. PLoS Negl Trop Dis, 2013, 7(5): e2195.
16.	Nagaraja V, Suh W, Fischman DL, et al. Transcatheter aortic valve replacement outcomes in bicuspid compared to trileaflet aortic valves. Cardiovasc Revasc Med, 2019, 20(1): 50-56.
17.	Xiong TY, Wang X, Li YJ, et al. Less pronounced reverse left ventricular remodeling in patients with bicuspid aortic stenosis treated with transcatheter aortic valve replacement compared to tricuspid aortic stenosis. Int J Cardiovasc Imaging, 2018, 34(11): 1761-1767.
18.	Song G, Jilaihawi H, Wang M, et al. Severe symptomatic bicuspid and tricuspid aortic stenosis in china: characteristics and outcomes of transcatheter aortic valve replacement with the Venus-A valve. Structural Heart, 2018, 2(1): 60-68.
19.	Aalaei-Andabili SH, Beaver TM, Petersen JW, et al. Early and midterm outcomes of transcatheter aortic valve replacement in patie-nts with bicuspid aortic valves. J Card Surg, 2018, 33(9): 489-496.
20.	Tung M, Wang X, Li F, et al. A versatile transapical device for aortic valvular disease: One-year outcomes of a multicenter study on the J-Valve system. J Cardiol, 2018, 72(5): 377-384.
21.	De Biase C, Mastrokostopoulos A, Philippart R, et al. Aortic valve anatomy and outcomes after transcatheter aortic valve implanta-tion in bicuspid aortic valves. Int J Cardiol, 2018, 266: 56-60.
22.	Liao YB, Li YJ, Xiong TY, et al. Comparison of procedural, clinical and valve performance results of transcatheter aortic valve replacement in patients with bicuspid versus tricuspid aortic stenosis. Int J Cardiol, 2018, 254: 69-74.
23.	Sannino A, Cedars A, Stoler RC, et al. Comparison of efficacy and safety of transcatheter aortic valve implantation in patients with bicuspid versus tricuspid aortic valves. Am J Cardiol, 2017, 120(9): 1601-1606.
24.	Arai T, Lefèvre T, Hovasse T, et al. The feasibility of transcatheter aortic valve implantation using the Edwards SAPIEN 3 for patients with severe bicuspid aortic stenosis. J Cardiol, 2017, 70(3): 220-224.
25.	Yoon SH, Bleiziffer S, De Backer O, et al. Outcomes in transcatheter aortic valve replacement for bicuspid versus tricuspid aortic valve stenosis. J Am Coll Cardiol, 2017, 69(21): 2579-2589.
26.	Liu XB, Jiang JB, Zhou QJ, et al. Evaluation of the safety and efficacy of transcatheter aortic valve implantation in patients with a severe stenotic bicuspid aortic valve in a Chinese population. J Zhejiang Univ Sci B, 2015, 16(3): 208-214.
27.	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.
28.	Kochman J, Huczek Z, Scisło P, et al. Comparison of one- and 12-month outcomes of transcatheter aortic valve replacement in patients with severely stenotic bicuspid versus tricuspid aortic valves (results from a multicenter registry). Am J Cardiol, 2014, 114(5): 757-762.
29.	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.
30.	Hayashida K, Bouvier E, Lefevre T, et al. Transcatheter aortic valve implantation for patients with severe bicuspid aortic valve stenosis. Circ Cardiovasc Interv, 2013, 6(3): 284-291.
31.	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.
32.	Novaro GM, Tiong IY, Pearce GL, et al. Features and predictors of ascending aortic dilatation in association with a congenital bicuspid aortic valve. Am J Cardiol, 2003, 92(1): 99-101.
33.	Hahn RT, Little SH, Monaghan MJ, et al. Recommendations for comprehensive intraprocedural echocardiographic imaging during TAVR. JACC Cardiovasc Imaging, 2015, 8(3): 261-287.
34.	Vahanian A, Alfieri O, Andreotti F, et al. Guidelines on the management of valvular heart disease (version 2012): the Joint Task Force on the Management of Valvular Heart Disease of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS). Eur J Cardiothorac Surg, 2012, 42(4): S1-S44.
35.	Phan K, Wong S, Phan S, et al. Transcatheter aortic valve implantation (TAVI) in patients with bicuspid aortic valve stenosis--systematic review and meta-analysis. Heart Lung Circ, 2015, 24(7): 649-659.
36.	Perlman GY, Blanke P, Webb JG. Transcatheter aortic valve implantation in bicuspid aortic valve stenosis. EuroIntervention, 2016, 12(Y): Y42-45.
37.	Philip F, Faza NN, Schoenhagen P, et al. Aortic annulus and root characteristics in severe aortic stenosis due to bicuspid aortic valve and tricuspid aortic valves: implications for transcatheter aortic valve therapies. Catheter Cardiovasc Interv, 2015, 86(2): E88-E98.

1. Siu SC, Silversides CK. Bicuspid aortic valve disease. J Am Coll Cardiol, 2010, 55(25): 2789-2800.
2. Tadros TM, Klein MD, Shapira OM. Ascending aortic dilatation associated with bicuspid aortic valve: pathophysiology, molecular biology, and clinical implications. Circulation, 2009, 119(6): 880-890.
3. Nistri S, Basso C, Marzari C, et al. Frequency of bicuspid aortic valve in young male conscripts by echocardiogram. Am J Cardiol, 2005, 96(5): 718-721.
4. Michelena HI, Khanna AD, Mahoney D, et al. Incidence of aortic complications in patients with bicuspid aortic valves. JAMA, 2011, 306(10): 1104-1112.
5. Fernandes SM, Khairy P, Sanders SP, et al. Bicuspid aortic valve morphology and interventions in the young. J Am Coll Cardiol, 2007, 49(22): 2211-2214.
6. Nishimura RA, Otto CM, Bonow RO, et al. 2017 AHA/ACC focused update of the 2014 AHA/ACC guideline for the management of patients with valvular heart disease: A report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation, 2017, 135(25): e1159-e1195.
7. Nishimura RA, Otto CM, Bonow RO, et al. 2014 AHA/ACC guideline for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation, 2014, 129(23): e521-e643.
8. Colombo A, Latib A. Bicuspid aortic valve: any room for TAVR? J Am Coll Cardiol, 2014, 64(22): 2340-2342.
9. Kodali SK, Williams MR, Smith CR, et al. Two-year outcomes after transcatheter or surgical aortic-valve replacement. N Engl J Med, 2012, 366(18): 1686-1695.
10. Chen M, Feng Y, Mazzitelli D, et al. Transcatheter aortic valve implantation in a patient with severe bicuspid aortic valve stenosis and ascending aortic aneurysm. JACC Cardiovasc Interv, 2014, 7(7): e83-e84.
11. 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.
12. Wijesinghe N, Ye J, Rodes-Cabau J, et al. Transcatheter aortic valve implantation in patients with bicuspid aortic valve stenosis. JACC Cardiovasc Interv, 2010, 3(11): 1122-5.
13. Perlman GY, Blanke P, Dvir D, et al. Bicuspid aortic valve stenosis: favorable early outcomes with a next-generation transcatheter heart valve in a multicenter study. JACC Cardiovasc Interv, 2016, 9(8): 817-824.
14. Jadad AR, Moore RA, Carroll D, et al. Assessing the quality of reports of randomized clinical trials: is blinding necessary? Control Clin Trials, 1996, 17(1): 1-12.
15. Cota GF, de Sousa MR, Fereguetti TO, et al. Efficacy of anti-leishmania therapy in visceral leishmaniasis among HIV infected patients: a systematic review with indirect comparison. PLoS Negl Trop Dis, 2013, 7(5): e2195.
16. Nagaraja V, Suh W, Fischman DL, et al. Transcatheter aortic valve replacement outcomes in bicuspid compared to trileaflet aortic valves. Cardiovasc Revasc Med, 2019, 20(1): 50-56.
17. Xiong TY, Wang X, Li YJ, et al. Less pronounced reverse left ventricular remodeling in patients with bicuspid aortic stenosis treated with transcatheter aortic valve replacement compared to tricuspid aortic stenosis. Int J Cardiovasc Imaging, 2018, 34(11): 1761-1767.
18. Song G, Jilaihawi H, Wang M, et al. Severe symptomatic bicuspid and tricuspid aortic stenosis in china: characteristics and outcomes of transcatheter aortic valve replacement with the Venus-A valve. Structural Heart, 2018, 2(1): 60-68.
19. Aalaei-Andabili SH, Beaver TM, Petersen JW, et al. Early and midterm outcomes of transcatheter aortic valve replacement in patie-nts with bicuspid aortic valves. J Card Surg, 2018, 33(9): 489-496.
20. Tung M, Wang X, Li F, et al. A versatile transapical device for aortic valvular disease: One-year outcomes of a multicenter study on the J-Valve system. J Cardiol, 2018, 72(5): 377-384.
21. De Biase C, Mastrokostopoulos A, Philippart R, et al. Aortic valve anatomy and outcomes after transcatheter aortic valve implanta-tion in bicuspid aortic valves. Int J Cardiol, 2018, 266: 56-60.
22. Liao YB, Li YJ, Xiong TY, et al. Comparison of procedural, clinical and valve performance results of transcatheter aortic valve replacement in patients with bicuspid versus tricuspid aortic stenosis. Int J Cardiol, 2018, 254: 69-74.
23. Sannino A, Cedars A, Stoler RC, et al. Comparison of efficacy and safety of transcatheter aortic valve implantation in patients with bicuspid versus tricuspid aortic valves. Am J Cardiol, 2017, 120(9): 1601-1606.
24. Arai T, Lefèvre T, Hovasse T, et al. The feasibility of transcatheter aortic valve implantation using the Edwards SAPIEN 3 for patients with severe bicuspid aortic stenosis. J Cardiol, 2017, 70(3): 220-224.
25. Yoon SH, Bleiziffer S, De Backer O, et al. Outcomes in transcatheter aortic valve replacement for bicuspid versus tricuspid aortic valve stenosis. J Am Coll Cardiol, 2017, 69(21): 2579-2589.
26. Liu XB, Jiang JB, Zhou QJ, et al. Evaluation of the safety and efficacy of transcatheter aortic valve implantation in patients with a severe stenotic bicuspid aortic valve in a Chinese population. J Zhejiang Univ Sci B, 2015, 16(3): 208-214.
27. 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.
28. Kochman J, Huczek Z, Scisło P, et al. Comparison of one- and 12-month outcomes of transcatheter aortic valve replacement in patients with severely stenotic bicuspid versus tricuspid aortic valves (results from a multicenter registry). Am J Cardiol, 2014, 114(5): 757-762.
29. 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.
30. Hayashida K, Bouvier E, Lefevre T, et al. Transcatheter aortic valve implantation for patients with severe bicuspid aortic valve stenosis. Circ Cardiovasc Interv, 2013, 6(3): 284-291.
31. 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.
32. Novaro GM, Tiong IY, Pearce GL, et al. Features and predictors of ascending aortic dilatation in association with a congenital bicuspid aortic valve. Am J Cardiol, 2003, 92(1): 99-101.
33. Hahn RT, Little SH, Monaghan MJ, et al. Recommendations for comprehensive intraprocedural echocardiographic imaging during TAVR. JACC Cardiovasc Imaging, 2015, 8(3): 261-287.
34. Vahanian A, Alfieri O, Andreotti F, et al. Guidelines on the management of valvular heart disease (version 2012): the Joint Task Force on the Management of Valvular Heart Disease of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS). Eur J Cardiothorac Surg, 2012, 42(4): S1-S44.
35. Phan K, Wong S, Phan S, et al. Transcatheter aortic valve implantation (TAVI) in patients with bicuspid aortic valve stenosis--systematic review and meta-analysis. Heart Lung Circ, 2015, 24(7): 649-659.
36. Perlman GY, Blanke P, Webb JG. Transcatheter aortic valve implantation in bicuspid aortic valve stenosis. EuroIntervention, 2016, 12(Y): Y42-45.
37. Philip F, Faza NN, Schoenhagen P, et al. Aortic annulus and root characteristics in severe aortic stenosis due to bicuspid aortic valve and tricuspid aortic valves: implications for transcatheter aortic valve therapies. Catheter Cardiovasc Interv, 2015, 86(2): E88-E98.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Comparing clinical outcomes between bicuspid and tricuspid aortic valve stenosis after transcatheter aortic valve replacement: A systematic review and meta-analysis

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