Comparing outcomes after transcatheter aortic valve replacement in patients with stenotic bicuspid and tricuspid aortic valve: A systematic review and meta‐analysis

Kanjanahattakij, Napatt; Horn, Benjamin; Vutthikraivit, Wasawat; Biso, Sylvia; Ziccardi, Mary Rodriguez; Lu, Marvin; Rattanawong, Pattara

doi:10.1002/clc.22992

Cited by 32 publications

(19 citation statements)

References 36 publications

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“…In our study, a higher rate of moderate-to-severe prosthetic valve regurgitation and decreased device success had no impact on one-year all-cause mortality. A recent meta-analysis reported similar findings and also a significantly increased conversion to open aortic valve in patients with BAV after TAVR [31]. Thus, a possible explanation for the lack of difference in one-year mortality between both groups could be the early diagnosis and surgical treatment of moderate-to-severe prosthetic valve regurgitation before cardiac remodeling and clinical deterioration occur.…”

Section: Discussionmentioning

confidence: 61%

One-Year Mortality in Patients Undergoing Transcatheter Aortic Valve Replacement for Stenotic Bicuspid versus Tricuspid Aortic Valves: A Meta-Analysis and Meta-Regression

Quintana

Monlezun

daSilva‐deAbreu³

et al. 2019

Journal of Interventional Cardiology

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Objective. To assess 1-year mortality after transcatheter aortic valve replacement (TAVR) in patients with bicuspid aortic stenosis (AS). Background. Clinical trials have proven the beneficial effect of TAVR on mortality in patients with tricuspid AS. Individuals with bicuspid AS were excluded from these trials. Methods. A meta-analysis using literature search from the Cochrane, PubMed, ClinicalTrials, SCOPUS, and EMBASE databases was conducted to determine the effect of TAVR on 1-year mortality in patients with bicuspid AS. Short-term outcomes that could potentially impact one-year mortality were analyzed. Results. After evaluating 380 potential articles, 5 observational studies were selected. A total of 3890 patients treated with TAVR were included: 721 had bicuspid and 3,169 had tricuspid AS. No statistically significant difference between the baseline characteristics of the two groups of patients was seen outside of mean aortic gradient. Our primary endpoint of one-year all-cause mortality revealed 85 deaths in 719 patients (11.82%) with bicuspid AS compared to 467 deaths in 3100 patients (15.06%) with tricuspid AS, with no difference between both groups [relative risk (RR) 1.03; 95% CI 0.70-1.51]. Patients with bicuspid AS were associated with a decrease in device success (RR 0.62; 95% CI 0.45-0.84) and an increase in moderate-to-severe prosthetic valve regurgitation (RR 1.55; 95% CI 1.07-2.22) after TAVR compared to patients with tricuspid AS. The effect of meta-regression coefficients on one-year all-cause mortality was not statistically significant for any patient baseline characteristics. Conclusion. When comparing TAVR procedure in tricuspid AS versus bicuspid AS, there was no difference noted in one-year all-cause mortality.

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Section: Discussionmentioning

confidence: 61%

One-Year Mortality in Patients Undergoing Transcatheter Aortic Valve Replacement for Stenotic Bicuspid versus Tricuspid Aortic Valves: A Meta-Analysis and Meta-Regression

Quintana

Monlezun

daSilva‐deAbreu³

et al. 2019

Journal of Interventional Cardiology

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“…However, there have been numerous case series and cohort studies ( Table 1) which show that TAVR in carefully selected patients with BAV is feasible, safe and may have a similar outcome to TAVR in tri-leaflet aortic valve (TAV) stenosis. Recently, large multinational BAV registries (13)(14)(15) and meta-analyses (16,17) on post-procedural outcomes in BAV patients have been impressive. To our knowledge, our study is the largest and most current systematic review analyzing current data on short and mid-term outcomes of TAVR in Patients with BAV stenosis.…”

Section: Introductionmentioning

confidence: 99%

Outcomes of transcatheter aortic valve replacement in bicuspid aortic valve stenosis

Bob‐Manuel¹,

Heckle²,

Ifedili³

et al. 2019

Ann. Transl. Med

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Background: Due to abnormal valve geometry, patients with bicuspid aortic valve (BAV) have been excluded in many transcatheter aortic valve replacement (TAVR) trials resulting in very limited data with regards to its safety and efficacy. Methods: We searched electronic databases including Cochrane Database of Systematic Reviews, MEDLINE and EMBASE for all studies including case series, and original reports published before December 2018 that assessed outcomes following TAVR in BAV stenosis. We also included studies that had patients with TAV for comparison. Pooled effect size was calculated with a random-effect model and weighted for the inverse of variance, to compare outcomes post-TAVR between BAV and TAV. The heterogeneity of effect estimates across the studies was assessed using I2. Publication bias was assessed with funnel plots. Statistical analysis was performed using SPSS version 24 (IBM Corp., SPSS Statistics for Windows, Version 24.0. Armonk, NY.) Results: A total of 19 studies describing 1,332 patients with BAV and 3,610 with TAV. There was no significant difference in the30-day mortality between patients with BAV and TAV [odds ratio (OR): 1.18, 95% confidence interval (CI): 0.7-1.7, P=0.41, I 2 =0]. One-year mortality rate in the BAV population was 13.1% compared to 15.4% in the TAV patients (P=0.75). Patients with BAV had significantly more moderate to severe paravalvular leak (PVL) post TAVR (PVL ≥3) 8.8% vs. 4.2% in TAV patients (OR: 1.478, 95% CI: 1.000-2.184, P=0.050, I 2 =0. Device success was significantly higher in TAV patients compared to BAV patients 93.5% vs. 87% (OR: 0.63, 95% CI: 0.49-0.86, P=0.003). Conclusions: TAVR in patients with BAV is associated with a high incidence of paravalvular regurgitation with a comparable 30-day mortality rate to TAV patients. The use of newer generation valve prosthesis improved outcomes.

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“…Others have shown reduced helical flow with TAVI (Edwards Sapien XT) compared to bioprosthetic AVR, but still abnormal compared to healthy controls ( 60 ). Patients with BAV undergoing TAVI are more likely to suffer device failure, paravalvular leak and conversion to surgery in one meta-analysis ( 67 ), complicating the decision making process.…”

Section: Discussionmentioning

confidence: 99%

Hemodynamic Profiles Before and After Surgery in Bicuspid Aortic Valve Disease—A Systematic Review of the Literature

Cave

Panayiotou

Bissell

2021

Front. Cardiovasc. Med.

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Bicuspid aortic valve (BAV) disease presents a unique management challenge both pre- and post-operatively. 4D flow MRI offers multiple tools for the assessment of the thoracic aorta in aortic valve disease. In particular, its assessment of flow patterns and wall shear stress have led to new understandings around the mechanisms of aneurysm development in BAV disease. Novel parameters have now been developed that have the potential to predict pathological aortic dilatation and may help to risk stratify BAV patients in future. This systematic review analyses the current 4D flow MRI literature after aortic valve and/or ascending aortic replacement in bicuspid aortic valve disease. 4D flow MRI has also identified distinct challenges posed by this cohort at the time of valve replacement compared to standard management of tri-leaflet disorders, and may help tailor the type and timing of replacement. Eccentric pathological flow patterns seen after bioprosthetic valve implantation, but not with mechanical prostheses, might be an important future consideration in intervention planning. 4D flow MRI also has promising potential in supporting the development of artificial valve prostheses and aortic conduits with more physiological flow patterns.

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Comparing outcomes after transcatheter aortic valve replacement in patients with stenotic bicuspid and tricuspid aortic valve: A systematic review and meta‐analysis

Abstract: There was no difference in mortality post-TAVR in patients with BAV compared with TAV. Further randomized studies should be done in newer-generation prostheses to assess this association.

Cited by 32 publications

References 36 publications

One-Year Mortality in Patients Undergoing Transcatheter Aortic Valve Replacement for Stenotic Bicuspid versus Tricuspid Aortic Valves: A Meta-Analysis and Meta-Regression

One-Year Mortality in Patients Undergoing Transcatheter Aortic Valve Replacement for Stenotic Bicuspid versus Tricuspid Aortic Valves: A Meta-Analysis and Meta-Regression

Outcomes of transcatheter aortic valve replacement in bicuspid aortic valve stenosis

Hemodynamic Profiles Before and After Surgery in Bicuspid Aortic Valve Disease—A Systematic Review of the Literature

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