Feasibility and Outcomes of Transcatheter Aortic Valve Implantation in High-Risk Patients With Stenotic Bicuspid Aortic Valves

Evaluation of the safety and efficacy of transcatheter aortic valve implantation in patients with a severe stenotic bicuspid aortic valve in a Chinese population

“…As noted, the proportion of patients with a BAV (15 of 40, 37.5%) in this study was much higher than those of previous studies in Europe (3.0% to 9.2%) (Himbert et al, 2012;Hayashida et al, 2013;Bauer et al, 2014;Costopoulos et al, 2014;Kochman et al, 2014). This phenomenon has also been observed in almost every center that performs TAVI in China, and in some centers as many as 50% of the patients who underwent TAVI had a BAV.…”

“…Valve-related dysfunction requiring repeat procedure 0 (0%) 0 (0%) 0 (0%) 1.00 Many studies and some case reports have demonstrated a positive effect of TAVI when used on BAV patients whose condition is inoperable or has a high surgical risk (Wijesinghe et al, 2010;Himbert et al, 2012;Hayashida et al, 2013;Bauer et al, 2014;Costopoulos et al, 2014;Kochman et al, 2014). However, experience from Asian populations, especially from China, is scarce.…”

“…However, BAV is the most common congenital heart disease, occurring in 0.5% to 2.0% of the general population (Roberts, 1970;Nistri et al, 2005;Tutar et al, 2005), and has been observed in about 50% of aortic valves resected during surgical aortic valve replacement (SAVR) (Roberts and Ko, 2005). Although several groups have reported the feasibility, efficacy, and safety of TAVI for patients with a BAV (Wijesinghe et al, 2010;Himbert et al, 2012;Hayashida et al, 2013;Bauer et al, 2014;Costopoulos et al, 2014;Kochman et al, 2014), global experience of the procedure is lacking, especially in China.…”

“…Despite the great improvements achieved in recent years, unfortunately, TAVI for patients with a bicuspid aortic valve (BAV) is still deemed to be a relative contraindication because of the exclusion of these patients from most clinical trials (Leon et al, 2010;Smith et al, 2011). One possible concern is the unfavorable anatomy of a BAV, which will result in elliptical deployment of a bioprosthesis, increase the procedural complications including residual aortic regurgitation, coronary obstruction, annulus rupture and aortic dissection, and decrease the durability of the bioprosthesis (Zegdi et al, 2008;Wijesinghe et al, 2010;Himbert et al, 2012). However, BAV is the most common congenital heart disease, occurring in 0.5% to 2.0% of the general population (Roberts, 1970;Nistri et al, 2005;Tutar et al, 2005), and has been observed in about 50% of aortic valves resected during surgical aortic valve replacement (SAVR) (Roberts and Ko, 2005).…”

Current Topics on Bicuspid Aortic Valve: Clinical Aspects and Surgical Management

“…55) Although O'Sullivan et al showed the implications of BAV for TAVI including case reports and current series, 56) we here summarized clinical series of the early outcomes of TAVI for BAV with the most recently published studies in Table 3. [52][53][54][57][58][59] Close preoperative and intraoperative analyses of the aortic valve anatomy are mandatory for successful TAVI in BAV cases. Further studies are needed to confirm the feasibility of implanting commercially available stent valves into selected bicuspid AS, and mid-term and long-term echocardiographic studies are mandatory in order to obtain more information on stent functioning in BAV in terms of stress, durability, leaflet tears, deterioration, dislodgement, malfunctioning, early stenosis, or paravalvular leaks.…”