Outcomes in Transcatheter Aortic Valve Replacement for Bicuspid Versus Tricuspid Aortic Valve Stenosis

Yoon, Sung Han; Bleiziffer, Sabine; Backer, Ole De; Delgado, Victoria; Arai, T.; Ziegelmueller, Johannes; Barbanti, Marco; Sharma, Rahul; Perlman, Gidon; Khalique, Omar; Holy, Erik W.; Saraf, Smriti; Deuschl, Florian; Fujita, Buntaro; Ruile, Philipp; Neumann, Franz Josef; Pache, Gregor; Takahashi, Minoru; Kaneko, Hidehiro; Schmidt, Tobias; Ohno, Yohei; Schofer, Niklas; Kong, William Kok-Fai; Tay, Edgar; Sugiyama, Daisuke; Kawamori, Hiroyuki; Maeno, Yoshio; Abramowitz, Yigal; Chakravarty, Tarun; Nakamura, Mamoo; Kuwata, Shingo; Yong, Gerald; Kao, Hsien‐Li; Lee, Michael; Kim, Hyo Soo; Modine, Thomas; Wong, S. Chiu; Bedgoni, Francesco; Testa, Luca; Teiger, Emmanuel; Butter, Christian; Ensminger, Stephan; Schäefer, Ulrich; Dvir, Danny; Blanke, Philipp; Leipsic, Jonathon; Nietlispach, Fabiàn; Abdel‐Wahab, Mohamed; Chevalier, Bernard; Tamburino, Corrado; Hildick‐Smith, David; Whisenant, Brian; Park, Seung Jung; Colombo, Antonio; Latib, Azeem; Kodali, Susheel; Bax, Jeroen J.; Søndergaard, Lars; Webb, John G.; Lefèvre, Thierry; Leon, Martin B.; Makkar, Raj

doi:10.1016/j.jacc.2017.03.017

Cited by 384 publications

(267 citation statements)

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“…[43][44][45] The Bicuspid Transcatheter Aortic Valve Replacement Registry is the largest international, multicenter, observational registry that enrolls all consecutive patients with bicuspid AS from Europe, North America, and Asia-Pacific regions. 44,45 In the published studies, TAVR devices were divided into early generation (Sapien XT, Edwards Lifesciences, Irvine, California; CoreValve, Medtronic, Minneapolis, Minnesota) versus new generation devices (Sapien 3, Edwards Lifesciences, Irvine, California; Lotus, Boston Scientific, Marlborough, Massachusetts; Evolut R, Medtronic, Minneapolis, Minnesota). Implantations of new generation devices were less likely to result in residual moderate to severe paravalvular leak, annulus rupture or second valve-in-valve implantation.…”

Section: Transcatheter Aortic Valve Replacementmentioning

confidence: 99%

“…Cumulative event rates for all-cause mortality were similar between bicuspid and tricuspid aortic valves. 45 Despite the foregoing data, selection bias nearly always exists whereby TAVR was generally performed in highrisk or inoperable bicuspid AS patients. In addition, bicuspid AS patients are more likely to be younger, [43][44][45] and the long-term implications of age-related progressive aortic dilatation and its complications need to be included in the decision-making process.…”

Section: Transcatheter Aortic Valve Replacementmentioning

confidence: 99%

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Bicuspid Aortic Valve Disease: New Insights

Wang

Delgado

et al. 2017

Structural Heart

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Bicuspid aortic valve (BAV) is the most common cardiac congenital abnormality and can be associated with significant valvulopathy or aortopathy. Current active areas of BAV research include prediction of development of valve dysfunction and aortopathy, and the various surgical valvular strategies with or without ascending aortic replacement. There is also increasing interest in the emerging role of transcatheter aortic valve replacement (TAVR) even though it is listed as a relative contraindication in current TAVR recommendations. Although there are clearly established guidelines in the clinical management and surgical techniques for the management of BAV with or without aortopathy, many of these newer surgical techniques have shown excellent post-surgical results but need to be directly compared against "standard" guidelines recommended treatment. As such, this creates new controversies regarding the clinical and surgical management of BAV. In this review, we have summarized the current understanding of the pathophysiology of BAV valvulopathy and aortopathy, various newer surgical therapies, and gaps in our scientific knowledge that require further research.

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Section: Transcatheter Aortic Valve Replacementmentioning

confidence: 99%

Section: Transcatheter Aortic Valve Replacementmentioning

confidence: 99%

Bicuspid Aortic Valve Disease: New Insights

Wang

Delgado

et al. 2017

Structural Heart

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“…Two recent studies on early generation TAVI devices showed a higher incidence of THV malposition requiring multiple THVs implantation (7.2%) and moderate or severe PVR that was found in 28.4 and 15.9% of patients, respectively [10,11]. In a large multicenter propensity-based analysis comparing TAVI outcomes in bicuspid aortic valves versus tricuspid aortic valves, Yoon et al [11] showed that among the early generation THV group, TAVI in patients with bicuspid AS was complicated more frequently with aortic root injury, mainly related to the Sapien XT implantation, implantation of more than one THV and moderate or severe paravalvular regurgitation, mainly related to the CoreValve implantation.…”

Section: Tavi In Bicuspid Aortic Valvesmentioning

confidence: 99%

“…In a large multicenter propensity-based analysis comparing TAVI outcomes in bicuspid aortic valves versus tricuspid aortic valves, Yoon et al [11] showed that among the early generation THV group, TAVI in patients with bicuspid AS was complicated more frequently with aortic root injury, mainly related to the Sapien XT implantation, implantation of more than one THV and moderate or severe paravalvular regurgitation, mainly related to the CoreValve implantation. Among the group treated with the new generation devices, however, there were no significant differences in procedural outcomes between bicuspid and tricuspid valves.…”

Section: Tavi In Bicuspid Aortic Valvesmentioning

confidence: 99%

“…Among the group treated with the new generation devices, however, there were no significant differences in procedural outcomes between bicuspid and tricuspid valves. This study suggested that the advancements incorporated by the new-generation TAVI devices accomplished to partially overcome some of the limitations encountered in treating bicuspid valves [11,12].…”

Section: Tavi In Bicuspid Aortic Valvesmentioning

confidence: 99%

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Hot Topics in Transcatheter Aortic Valve Implantation

2017

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Bicuspid Aortic Valve Stenosis

Barker

Reardon

2019

JAMA

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Transcatheter aortic valve replacement (TAVR) has revolutionized the treatment of aortic stenosis. A series of trials in which patients were randomized to receive TAVR or surgical valve replacement have provided arguably the best data collected for this intervention. [1][2][3][4][5][6] The 2 most recent randomized clinical trials involving patients who have less than 3% risk of surgical operative mortality suggest that TAVR might be the preferred treatment strategy for this particular patient group. 5,6 The patient group tested is a critical factor for all randomized clinical trials and determines the potential for generalizability. The data from the trials involving low-risk patients are compelling and should lead to both a class I indication for TAVR in low-risk patients as well as commercial approval in the United States. When this occurs, the clinicians who provide care for patients with structural heart disease will need to grapple with patient age and whether TAVR is appropriate for patients who had been excluded from previous TAVR trials because of their bicuspid aortic valves. The mean age of the patients in the 2 randomized clinical trials involving patients at lower risk of surgical mortality 5,6 was 10 years younger than patients at higher risk of surgical mortality (73-74 years). The prevalence of bicuspid aortic valves in the patient group older than age 80 years is about 20% but is approximately 60% among younger patients aged 60 through 80 years 7 and will represent a greater percentage of the patients who are evaluated for severe aortic stenosis. Understanding the ability to treat bicuspid aortic valve in its various phenotypes with TAVR and the risks involved is a primary concern for the subspecialty area of structural heart disease.A previous study suggested that the first-generation TAVR valves had suboptimal outcomes in patients with bicuspid aortic valves but that later-generation valves might have outcomes similar to those seen in patients with trileaflet valves. 8 In the study by Makkar and colleagues 9 reported in this issue of JAMA, the authors examined outcomes for TAVR using the current-generation Sapien S3 valve from the Transcatheter Valve Therapies (TVT) Registry for patients at high-or intermediaterisk. This large study included 81 822 consecutive patients having TAVR using the current-generation valve, of which 2726 had bicuspid aortic valve TAVR and 79 096 had trileaflet TAVR. Propensity matching based on 25 covariates was used to generate 2691 similar pairs. The primary outcomes analyzed were 30-day and 1-year mortality and risk of stroke. Secondary outcomes included procedural complications, hemodynamic measures, and quality-of-life measurement.

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Outcomes in Transcatheter Aortic Valve Replacement for Bicuspid Versus Tricuspid Aortic Valve Stenosis

Abstract: Compared with tricuspid AS, TAVR in bicuspid AS was associated with a similar prognosis, but lower device success rate. Procedural differences were observed in patients treated with the early-generation devices, whereas no differences were observed with the new-generation devices.

Cited by 384 publications

References 32 publications

Bicuspid Aortic Valve Disease: New Insights

Bicuspid Aortic Valve Disease: New Insights

Hot Topics in Transcatheter Aortic Valve Implantation

Bicuspid Aortic Valve Stenosis

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