Efficacy and Safety of Transcatheter Aortic Valve Implantation for Bicuspid Aortic Valves: A Systematic Review and Meta-Analysis

Xie, Xiaochuan; Shi, Xiaohan; Xun, Xiaoshuang; Li, Rao

doi:10.5761/atcs.ra.16-00032

Cited by 12 publications

(13 citation statements)

References 34 publications

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“…Among the reasons that led to consider BAV patients at high risk for TAVI procedures are some characteristics of the aortic annulus such as a more elliptic shape than in patients with TAV. This different conformation has been suggested as the cause for the higher rate of paravalvular regurgitation in BAV patients [10,14,33,34]. With an AR > 1 at all phases and for all BAV types, but significantly more in early systolic phase for valves type 1, our study demonstrated that the annulus of BAV patients has an elliptic shape.…”

Section: Discussionsupporting

confidence: 47%

Bicuspid aortic valve annulus: assessment of geometry and size changes during the cardiac cycle as measured with a standardized method to define the annular plane

et al. 2021

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Purpose Bicuspid aortic valve (BAV) is a complex malformation affecting not merely the aortic valve. However, little is known regarding the dynamic physiology of the aortic annulus in these patients and whether it is similar to tricuspid aortic valves (TAV). Determining the BAV annular plane is more challenging than for TAV. Our aim was to present a standardized methodology to determine BAV annulus and investigate its changes in shape and dimensions during the cardiac cycle. Methods BAV patients were prospectively included and underwent an ECG-gated cardiac CTA. The annulus plane was manually identified on reconstructions at 5% intervals of the cardiac cycle with a new standardized method for different BAV types. Based on semi-automatically defined contours, maximum and minimum diameter, area, area-derived diameter, perimeter, asymmetry ratio (AR), and relative area were calculated. Differences of dynamic annular parameters were assessed also per BAV type. Results Of the 55 patients included (38.4 ± 13.3 years; 58% males), 38 had BAV Sievers type 1, 10 type 0, and 7 type 2. The minimum diameter, perimeter, area, and area-derived diameter were significantly higher in systole than in diastole with a relative change of 13.7%, 4.8%, 13.7%, and 7.2% respectively (all p < 0.001). The AR was ≥ 1.1 in all phases, indicating an elliptic shape, with more pronounced flattening in diastole (p < 0.001). Different BAV types showed comparable dynamic changes. Conclusions BAV annulus undergo significant changes in shape during the cardiac cycle with a wider area in systole and a more elliptic conformation in diastole regardless of valve type. Key Points • A refined method for the identification of the annulus plane on CT scans of patients with bicuspid aortic valves, tailored for the specific anatomy of each valve type, is proposed. • The annulus of patients with bicuspid aortic valves undergoes significant changes during the cardiac cycle with a wider area and more circular shape in systole regardless of valve type. • As compared to previously published data, the bicuspid aortic valve annulus has physiological dynamics similar to that encountered in tricuspid valves but with overall larger dimensions.

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Section: Discussionsupporting

confidence: 47%

Bicuspid aortic valve annulus: assessment of geometry and size changes during the cardiac cycle as measured with a standardized method to define the annular plane

et al. 2021

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“…Secondary endpoints such as 30-day permanent pacemaker (PPM) implantation, moderate-to-severe prosthetic valve regurgitation, acute kidney injury and composite clinical endpoints 30-day safety, and device success defined in the Valve Academic Research Consortium 2 (VARC-2) were evaluated to detect early differences between both groups which could impact one-year mortality [19]. Short-term outcomes have been previously pooled and reported in meta-analysis by others; thus our literature review was designated to evaluate one-year mortality [20].…”

Section: Methodsmentioning

confidence: 99%

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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“…Although it seems straightforward to proceed with transcatheter replacement for a TAS in nonsurgical candidates, it becomes challenging to choose TAVR in a similar patient with BAV especially with aortic root dilatation and demands experience, discussion, and consensus among various members of a multidisciplinary team. TAVR for BAV remains an off-label indication and carries a higher risk of paravalvular regurgitation [5]. Moreover, there is an additional risk of malpositioning, maldeployment, and malexpansion of the transcatheter AV prosthesis due to asymmetric, excessively calcified larger annulus of BAV [5].…”

Section: Discussionmentioning

confidence: 99%

“…TAVR for BAV remains an off-label indication and carries a higher risk of paravalvular regurgitation [5]. Moreover, there is an additional risk of malpositioning, maldeployment, and malexpansion of the transcatheter AV prosthesis due to asymmetric, excessively calcified larger annulus of BAV [5].…”

Section: Discussionmentioning

confidence: 99%

Transcatheter bicuspid aortic valve replacement in Turner syndrome: A unique experience of interventional cardiologist

Ahmad

Wahab

Khan

et al. 2018

Journal of Cardiology Cases

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A 69-year-old short-statured Turner syndrome (TS) patient with a history of poliomyelitis in childhood and moderate bicuspid aortic stenosis (BAS) reported worsening dyspnea and fatigue over six months. A repeat transthoracic echocardiogram revealed progression to severe aortic stenosis with dilated ascending aorta (AA). As part of the work-up for aortic valve replacement, the patient underwent cardiac catheterization, which revealed a severely calcified AV with an area of 0.5 sq. cm and a mean gradient of 37 mmHg. On coronary angiography, there was 70% stenosis of the proximal left anterior descending artery (LAD). Due to poor rehabilitation potential, she was deemed high-risk for surgical aortic valve replacement. A recommendation for transcatheter aortic valve replacement (TAVR) with stenting of the proximal LAD was made. Dilated AA was managed conservatively with serial noninvasive imaging. The patient underwent TAVR with Edwards-Sapien valve (23 mm S3) and stenting of proximal LAD. The procedure was successful without complications. To our knowledge, our patient is the first case of TAVR in BAS with aortopathy in TS.

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Efficacy and Safety of Transcatheter Aortic Valve Implantation for Bicuspid Aortic Valves: A Systematic Review and Meta-Analysis

Cited by 12 publications

References 34 publications

Bicuspid aortic valve annulus: assessment of geometry and size changes during the cardiac cycle as measured with a standardized method to define the annular plane

Bicuspid aortic valve annulus: assessment of geometry and size changes during the cardiac cycle as measured with a standardized method to define the annular plane

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

Transcatheter bicuspid aortic valve replacement in Turner syndrome: A unique experience of interventional cardiologist

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