Research progress of application of transcatheter aortic valve replacement in the bicuspid aortic valve stenosis_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

LI Weijie ^1,2 , LUO Jianfang ¹ , SUN Yinghao ¹ , CHEN Jiaohua ¹ , LUO Songyuan ¹ ,  LI Jie ¹

1. Department of Cardiology, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, 510080, P. R. China;
2. Department of Cardiology, The First People’s Hospital of Foshan, Foshan, 528000, Guangdong, P. R. China;

Corresponding author：

LI Jie, Email: leomoku1981@163.com

Keywords：

Transcatheter aortic valve replacement; bicuspid aortic valve; aortic valve stenosis; review

DOI：

10.7507/1007-4848.202211085

Video：

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Patients with bicuspid aortic valve (BAV) are characterized by asymmetric anatomy, severe calcification and combined aortic dilatation. Compared with tricuspid aortic valve stenosis patients, patients with BAV stenosis confront with greater surgical risks in transcatheter aortic valve replacement (TAVR), including paravalvular leak, aortic valve rupture, coronary artery obstruction, atrioventricular block and so on. However, with the advent of new generation of prosthetic valves and optimization of surgical strategies, several studies have shown that TAVR is safe and effective in the treatment of BAV stenosis. Therefore, we aim to provide an overview of the use of TAVR in patients with BAV stenosis.

Citation： LI Weijie, LUO Jianfang, SUN Yinghao, CHEN Jiaohua, LUO Songyuan, LI Jie. Research progress of application of transcatheter aortic valve replacement in the bicuspid aortic valve stenosis. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2023, 30(8): 1199-1203. doi: 10.7507/1007-4848.202211085 Copy

1.	Borger MA, Fedak PWM, Stephens EH, et al. The American Association for Thoracic Surgery consensus guidelines on bicuspid aortic valve-related aortopathy: Full online-only version. J Thorac Cardiovasc Surg, 2018, 156(2): e41-e74.
2.	Verma S, Siu SC. Aortic dilatation in patients with bicuspid aortic valve. N Engl J Med, 2014, 370(20): 1920-1929.
3.	Michelena HI, Desjardins VA, Avierinos JF, et al. Natural history of asymptomatic patients with normally functioning or minimally dysfunctional bicuspid aortic valve in the community. Circulation, 2008, 117(21): 2776-2784.
4.	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.
5.	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.
6.	Leon MB, Smith CR, Mack MJ, et al. Transcatheter or surgical aortic-valve replacement in intermediate-risk patients. N Engl J Med, 2016, 374(17): 1609-1620.
7.	Mack MJ, Leon MB, Thourani VH, et al. Transcatheter aortic-valve replacement with a balloon-expandable valve in low-risk patients. N Engl J Med, 2019, 380(18): 1695-1705.
8.	Otto CM, Nishimura RA, et al. 2020 ACC/AHA guideline for the management of patients with valvular heart disease: A report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. J Thorac Cardiovasc Surg, 2021, 162(2): e183-e353.
9.	周达新, 潘文志, 吴永健, 等. 经导管主动脉瓣置换术中国专家共识 (2020更新版). 中国介入心脏病学杂志, 2020, 28(6): 301-309.
10.	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.
11.	Perlman GY, Blanke P, Webb JG. Transcatheter aortic valve implantation in bicuspid aortic valve stenosis. EuroIntervention, 2016, 12(Y): Y42-Y45.
12.	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.
13.	Jilaihawi H, Chen M, Webb J, et al. A bicuspid aortic valve imaging classification for the TAVR era. JACC Cardiovasc Imaging, 2016, 9(10): 1145-1158.
14.	Nkomo VT, Enriquez-Sarano M, Ammash NM, et al. Bicuspid aortic valve associated with aortic dilatation: A community-based study. Arterioscler Thromb Vasc Biol, 2003, 23(2): 351-356.
15.	Fazel SS, Mallidi HR, Lee RS, et al. The aortopathy of bicuspid aortic valve disease has distinctive patterns and usually involves the transverse aortic arch. J Thorac Cardiovasc Surg, 2008, 135(4): 901-907.
16.	Tamburino C, Capodanno D, Ramondo A, et al. Incidence and predictors of early and late mortality after transcatheter aortic valve implantation in 663 patients with severe aortic stenosis. Circulation, 2011, 123(3): 299-308.
17.	Arnold SV, Zhang Y, Baron SJ, et al. Impact of short-term complications on mortality and quality of life after transcatheter aortic valve replacement. JACC Cardiovasc Interv, 2019, 12(4): 362-369.
18.	Kim WK, Renker M, Rolf A, et al. Annular versus supra-annular sizing for TAVI in bicuspid aortic valve stenosis. EuroIntervention, 2019, 15(3): e231-e238.
19.	Bugani G, Pagnesi M, Tchetchè D, et al. Predictors of high residual gradient after transcatheter aortic valve replacement in bicuspid aortic valve stenosis. Clin Res Cardiol, 2021, 110(5): 667-675.
20.	Kanjanahattakij N, Horn B, Vutthikraivit W, et al. Comparing outcomes after transcatheter aortic valve replacement in patients with stenotic bicuspid and tricuspid aortic valve: A systematic review and meta-analysis. Clin Cardiol, 2018, 41(7): 896-902.
21.	Jin Q, Li W, Chen S, et al. Aortic valve morphology and paravalvular leak regression after a self-expandable transcatheter aortic valve replacement. Front Physiol, 2023, 13: 1088681.
22.	Pasic M, Unbehaun A, Buz S, et al. Annular rupture during transcatheter aortic valve replacement: Classification, pathophysiology, diagnostics, treatment approaches, and prevention. JACC Cardiovasc Interv, 2015, 8(1 Pt A): 1-9.
23.	Fedak PW, Verma S, David TE, et al. Clinical and pathophysiological implications of a bicuspid aortic valve. Circulation, 2002, 106(8): 900-904.
24.	De Marchena E, Mesa J, Pomenti S, et al. Thrombus formation following transcatheter aortic valve replacement. JACC Cardiovasc Interv, 2015, 8(5): 728-739.
25.	Hatoum H, Dollery J, Lilly SM, et al. Sinus hemodynamics variation with tilted transcatheter aortic valve deployments. Ann Biomed Eng, 2019, 47(1): 75-84.
26.	Khodaee F, Barakat M, Abbasi M, et al. Incomplete expansion of transcatheter aortic valves is associated with propensity for valve thrombosis. Interact Cardiovasc Thorac Surg, 2020, 30(1): 39-46.
27.	Gunning PS, Saikrishnan N, McNamara LM, et al. An in vitro evaluation of the impact of eccentric deployment on transcatheter aortic valve hemodynamics. Ann Biomed Eng, 2014, 42(6): 1195-1206.
28.	Yeats BB, Yadav PK, Dasi LP, et al. Transcatheter aortic valve replacement for bicuspid aortic valve disease: Does conventional surgery have a future? Ann Cardiothorac Surg, 2022, 11(4): 389-401.
29.	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.
30.	Makkar RR, Yoon SH, Chakravarty T, et al. Association between transcatheter aortic valve replacement for bicuspid vs. tricuspid aortic stenosis and mortality or stroke among patients at low surgical risk. JAMA, 2021, 326(11): 1034-1044.
31.	Chen S, Chau KH, Nazif TM. The incidence and impact of cardiac conduction disturbances after transcatheter aortic valve replacement. Ann Cardiothorac Surg, 2020, 9(6): 452-467.
32.	Hamdan A, Nassar M, Schwammenthal E, et al. Short membranous septum length in bicuspid aortic valve stenosis increases the risk of conduction disturbances. J Cardiovasc Comput Tomogr, 2021, 15(4): 339-347.
33.	Mylotte D, Lefevre T, Søndergaard L, et al. Transcatheter aortic valve replacement in bicuspid aortic valve disease. J Am Coll Cardiol, 2014, 64(22): 2330-2339.
34.	Forrest JK, Mangi AA, Popma JJ, et al. Early outcomes with the Evolut PRO repositionable self-expanding transcatheter aortic valve with pericardial wrap. JACC Cardiovasc Interv, 2018, 11(2): 160-168.
35.	Yang TH, Webb JG, Blanke P, et al. Incidence and severity of paravalvular aortic regurgitation with multidetector computed tomography nominal area oversizing or undersizing after transcatheter heart valve replacement with the Sapien 3: A comparison with the Sapien XT. JACC Cardiovasc Interv, 2015, 8(3): 462-471.
36.	刘庆荣, 吕守良, 吴永健. 国产VenusA-Valve人工主动脉瓣膜的设计特点. 中国医刊, 2015, 50(1): 9-10.
37.	Makkar RR, Yoon SH, Leon MB, et al. Association between transcatheter aortic valve replacement for bicuspid vs. tricuspid aortic stenosis and mortality or stroke. JAMA, 2019, 321(22): 2193-2202.
38.	李捷, 孙英皓, 李光, 等. 经导管主动脉瓣置换术治疗二叶式与三叶式主动脉瓣狭窄中期预后的初步比较. 中华心血管病杂志, 2020, 48(9): 759-764.
39.	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.
40.	Niu G, Ali WB, Wang M, et al. Anatomical morphology of the aortic valve in Chinese aortic stenosis patients and clinical results after downsize strategy of transcatheter aortic valve replacement. Chin Med J (Engl), 2022, 135(24): 2968-2975.
41.	Iannopollo G, Romano V, Buzzatti N, et al. A novel supra-annular plane to predict TAVI prosthesis anchoring in raphe-type bicuspid aortic valve disease: The LIRA plane. EuroIntervention, 2020, 16(3): 259-261.
42.	Petronio AS, Angelillis M, De Backer O, et al. Bicuspid aortic valve sizing for transcatheter aortic valve implantation: Development and validation of an algorithm based on multi-slice computed tomography. J Cardiovasc Comput Tomogr, 2020, 14(5): 452-461.
43.	Liu X, He Y, Zhu Q, et al. Supra-annular structure assessment for self-expanding transcatheter heart valve size selection in patients with bicuspid aortic valve. Catheter Cardiovasc Interv, 2018, 91(5): 986-994.
44.	Kohli K, Wei ZA, Yoganathan AP, et al. Transcatheter mitral valve planning and the neo-LVOT: Utilization of virtual simulation models and 3D printing. Curr Treat Options Cardiovasc Med, 2018, 20(12): 99.
45.	Dowling C, Bavo AM, El Faquir N, et al. Patient-specific computer simulation of transcatheter aortic valve replacement in bicuspid aortic valve morphology. Circ Cardiovasc Imaging, 2019, 12(10): e009178.
46.	Lavon K, Marom G, Bianchi M, et al. Biomechanical modeling of transcatheter aortic valve replacement in a stenotic bicuspid aortic valve: Deployments and paravalvular leakage. Med Biol Eng Comput, 2019, 57(10): 2129-2143.

1. Borger MA, Fedak PWM, Stephens EH, et al. The American Association for Thoracic Surgery consensus guidelines on bicuspid aortic valve-related aortopathy: Full online-only version. J Thorac Cardiovasc Surg, 2018, 156(2): e41-e74.
2. Verma S, Siu SC. Aortic dilatation in patients with bicuspid aortic valve. N Engl J Med, 2014, 370(20): 1920-1929.
3. Michelena HI, Desjardins VA, Avierinos JF, et al. Natural history of asymptomatic patients with normally functioning or minimally dysfunctional bicuspid aortic valve in the community. Circulation, 2008, 117(21): 2776-2784.
4. 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.
5. 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.
6. Leon MB, Smith CR, Mack MJ, et al. Transcatheter or surgical aortic-valve replacement in intermediate-risk patients. N Engl J Med, 2016, 374(17): 1609-1620.
7. Mack MJ, Leon MB, Thourani VH, et al. Transcatheter aortic-valve replacement with a balloon-expandable valve in low-risk patients. N Engl J Med, 2019, 380(18): 1695-1705.
8. Otto CM, Nishimura RA, et al. 2020 ACC/AHA guideline for the management of patients with valvular heart disease: A report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. J Thorac Cardiovasc Surg, 2021, 162(2): e183-e353.
9. 周达新, 潘文志, 吴永健, 等. 经导管主动脉瓣置换术中国专家共识 (2020更新版). 中国介入心脏病学杂志, 2020, 28(6): 301-309.
10. 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.
11. Perlman GY, Blanke P, Webb JG. Transcatheter aortic valve implantation in bicuspid aortic valve stenosis. EuroIntervention, 2016, 12(Y): Y42-Y45.
12. 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.
13. Jilaihawi H, Chen M, Webb J, et al. A bicuspid aortic valve imaging classification for the TAVR era. JACC Cardiovasc Imaging, 2016, 9(10): 1145-1158.
14. Nkomo VT, Enriquez-Sarano M, Ammash NM, et al. Bicuspid aortic valve associated with aortic dilatation: A community-based study. Arterioscler Thromb Vasc Biol, 2003, 23(2): 351-356.
15. Fazel SS, Mallidi HR, Lee RS, et al. The aortopathy of bicuspid aortic valve disease has distinctive patterns and usually involves the transverse aortic arch. J Thorac Cardiovasc Surg, 2008, 135(4): 901-907.
16. Tamburino C, Capodanno D, Ramondo A, et al. Incidence and predictors of early and late mortality after transcatheter aortic valve implantation in 663 patients with severe aortic stenosis. Circulation, 2011, 123(3): 299-308.
17. Arnold SV, Zhang Y, Baron SJ, et al. Impact of short-term complications on mortality and quality of life after transcatheter aortic valve replacement. JACC Cardiovasc Interv, 2019, 12(4): 362-369.
18. Kim WK, Renker M, Rolf A, et al. Annular versus supra-annular sizing for TAVI in bicuspid aortic valve stenosis. EuroIntervention, 2019, 15(3): e231-e238.
19. Bugani G, Pagnesi M, Tchetchè D, et al. Predictors of high residual gradient after transcatheter aortic valve replacement in bicuspid aortic valve stenosis. Clin Res Cardiol, 2021, 110(5): 667-675.
20. Kanjanahattakij N, Horn B, Vutthikraivit W, et al. Comparing outcomes after transcatheter aortic valve replacement in patients with stenotic bicuspid and tricuspid aortic valve: A systematic review and meta-analysis. Clin Cardiol, 2018, 41(7): 896-902.
21. Jin Q, Li W, Chen S, et al. Aortic valve morphology and paravalvular leak regression after a self-expandable transcatheter aortic valve replacement. Front Physiol, 2023, 13: 1088681.
22. Pasic M, Unbehaun A, Buz S, et al. Annular rupture during transcatheter aortic valve replacement: Classification, pathophysiology, diagnostics, treatment approaches, and prevention. JACC Cardiovasc Interv, 2015, 8(1 Pt A): 1-9.
23. Fedak PW, Verma S, David TE, et al. Clinical and pathophysiological implications of a bicuspid aortic valve. Circulation, 2002, 106(8): 900-904.
24. De Marchena E, Mesa J, Pomenti S, et al. Thrombus formation following transcatheter aortic valve replacement. JACC Cardiovasc Interv, 2015, 8(5): 728-739.
25. Hatoum H, Dollery J, Lilly SM, et al. Sinus hemodynamics variation with tilted transcatheter aortic valve deployments. Ann Biomed Eng, 2019, 47(1): 75-84.
26. Khodaee F, Barakat M, Abbasi M, et al. Incomplete expansion of transcatheter aortic valves is associated with propensity for valve thrombosis. Interact Cardiovasc Thorac Surg, 2020, 30(1): 39-46.
27. Gunning PS, Saikrishnan N, McNamara LM, et al. An in vitro evaluation of the impact of eccentric deployment on transcatheter aortic valve hemodynamics. Ann Biomed Eng, 2014, 42(6): 1195-1206.
28. Yeats BB, Yadav PK, Dasi LP, et al. Transcatheter aortic valve replacement for bicuspid aortic valve disease: Does conventional surgery have a future? Ann Cardiothorac Surg, 2022, 11(4): 389-401.
29. 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.
30. Makkar RR, Yoon SH, Chakravarty T, et al. Association between transcatheter aortic valve replacement for bicuspid vs. tricuspid aortic stenosis and mortality or stroke among patients at low surgical risk. JAMA, 2021, 326(11): 1034-1044.
31. Chen S, Chau KH, Nazif TM. The incidence and impact of cardiac conduction disturbances after transcatheter aortic valve replacement. Ann Cardiothorac Surg, 2020, 9(6): 452-467.
32. Hamdan A, Nassar M, Schwammenthal E, et al. Short membranous septum length in bicuspid aortic valve stenosis increases the risk of conduction disturbances. J Cardiovasc Comput Tomogr, 2021, 15(4): 339-347.
33. Mylotte D, Lefevre T, Søndergaard L, et al. Transcatheter aortic valve replacement in bicuspid aortic valve disease. J Am Coll Cardiol, 2014, 64(22): 2330-2339.
34. Forrest JK, Mangi AA, Popma JJ, et al. Early outcomes with the Evolut PRO repositionable self-expanding transcatheter aortic valve with pericardial wrap. JACC Cardiovasc Interv, 2018, 11(2): 160-168.
35. Yang TH, Webb JG, Blanke P, et al. Incidence and severity of paravalvular aortic regurgitation with multidetector computed tomography nominal area oversizing or undersizing after transcatheter heart valve replacement with the Sapien 3: A comparison with the Sapien XT. JACC Cardiovasc Interv, 2015, 8(3): 462-471.
36. 刘庆荣, 吕守良, 吴永健. 国产VenusA-Valve人工主动脉瓣膜的设计特点. 中国医刊, 2015, 50(1): 9-10.
37. Makkar RR, Yoon SH, Leon MB, et al. Association between transcatheter aortic valve replacement for bicuspid vs. tricuspid aortic stenosis and mortality or stroke. JAMA, 2019, 321(22): 2193-2202.
38. 李捷, 孙英皓, 李光, 等. 经导管主动脉瓣置换术治疗二叶式与三叶式主动脉瓣狭窄中期预后的初步比较. 中华心血管病杂志, 2020, 48(9): 759-764.
39. 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.
40. Niu G, Ali WB, Wang M, et al. Anatomical morphology of the aortic valve in Chinese aortic stenosis patients and clinical results after downsize strategy of transcatheter aortic valve replacement. Chin Med J (Engl), 2022, 135(24): 2968-2975.
41. Iannopollo G, Romano V, Buzzatti N, et al. A novel supra-annular plane to predict TAVI prosthesis anchoring in raphe-type bicuspid aortic valve disease: The LIRA plane. EuroIntervention, 2020, 16(3): 259-261.
42. Petronio AS, Angelillis M, De Backer O, et al. Bicuspid aortic valve sizing for transcatheter aortic valve implantation: Development and validation of an algorithm based on multi-slice computed tomography. J Cardiovasc Comput Tomogr, 2020, 14(5): 452-461.
43. Liu X, He Y, Zhu Q, et al. Supra-annular structure assessment for self-expanding transcatheter heart valve size selection in patients with bicuspid aortic valve. Catheter Cardiovasc Interv, 2018, 91(5): 986-994.
44. Kohli K, Wei ZA, Yoganathan AP, et al. Transcatheter mitral valve planning and the neo-LVOT: Utilization of virtual simulation models and 3D printing. Curr Treat Options Cardiovasc Med, 2018, 20(12): 99.
45. Dowling C, Bavo AM, El Faquir N, et al. Patient-specific computer simulation of transcatheter aortic valve replacement in bicuspid aortic valve morphology. Circ Cardiovasc Imaging, 2019, 12(10): e009178.
46. Lavon K, Marom G, Bianchi M, et al. Biomechanical modeling of transcatheter aortic valve replacement in a stenotic bicuspid aortic valve: Deployments and paravalvular leakage. Med Biol Eng Comput, 2019, 57(10): 2129-2143.

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