Transcatheter and surgical aortic valve replacement in patients with bicuspid aortic valve

Husso, Annastiina; Airaksinen, Juhani; Juvonen, Tatu; Laine, Mika; Dahlbacka, Sebastian; Virtanen, Marko; Niemelä, Matti; Mäkikallio, Timo H.; Savontaus, Mikko; Eskola, Markku; Raivio, Peter; Valtola, Antti; Biancari, Fausto

doi:10.1007/s00392-020-01761-3

Cited by 21 publications

(20 citation statements)

References 34 publications

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“…The route of access was reported in 18 studies, and 91.8% of procedures were transfemoral. The most common devices used were the CoreValve (Medtronic, Minneapolis, Minnesota, USA) and Evolut R (Medtronic) ( 15 , 18 , 25 - 27 , 29 , 30 , 32 - 41 ), used in 17 studies, and the SAPIEN 3 (Edwards Lifesciences, Irvine, California, USA) and SAPIEN XT valves (Edwards Lifesciences), used in 13 studies ( 15 , 26 , 30 , 32 - 40 , 42 ). The Lotus EDGE (Boston Scientific, Marlborough, Massachusetts, USA) was used in six studies ( 15 , 25 , 26 , 28 , 33 , 35 ) and the VenusA-valve (Venus MedTech, Hangzhou, China) was used in four studies from Mainland China ( 18 , 24 , 31 , 33 ).…”

Section: Resultsmentioning

confidence: 99%

“…Mean mortality at two years postprocedure was 12.9% (95% CI: 10.4-15.4%; I 2 =0%). Two papers reported mortality rates of 11.0% and 15.8% at their respective follow-ups of 2.1±1.6 and 2.86±1.47 years 0.062 (0.000, 0.146) 0.095 (0.000, 0.221) 0.048 (0.002, 0.094) 0.015 (0.000, 0.055) 0.006 (0.000, 0.022) 0.045 (0.000, 0.107) 0.036 (0.000, 0.084) 0.048 (0.000, 0.139) 0.133 (0.000, 0.305) 0.010 (0.000, 0.029) 0.042 (0.000, 0.122) 0.036 (0.000, 0.104) 0.016 (0.000, 0.060) 0.092 (0.031, 0.153) 0.060 (0.000, 0.126) 0.020 (0.000, 0.058) 0.008 (0.000, 0.030) 0.182 (0.000, 0.410) 0.020 (0.012, 0.029) Ev/Trt Estimate (95% CI) (Table 5, Figure 2), respectively (15,16). All P values were statistically significant.…”

Section: All-cause Mortalitymentioning

confidence: 99%

“…However, recently increasing off-label use of TAVR for BAV stenosis and improved valve technology have shown promising outcomes, comparable both to TAVR in TAV stenosis and to SAVR in BAV stenosis (14)(15)(16)(17)(18). These results primarily stem from high-risk patients ineligible for SAVR, but there remains optimism that TAVR could be a viable or preferred treatment for all patients with BAV stenosis.…”

Section: Introductionmentioning

confidence: 99%

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Procedural and clinical outcomes of transcatheter aortic valve replacement in bicuspid aortic valve patients: a systematic review and meta-analysis

Chen¹,

Jiang²,

Martin³

et al. 2022

Ann Cardiothorac Surg

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Background: Currently, bicuspid aortic valve (BAV) anatomy remains a relative contraindication for transcatheter aortic valve replacement (TAVR) due to concerns of suboptimal anatomy. However, recent advancements in the field have provided a wealth of promising data and more clinicians are opting for TAVR as an alternative to surgical repair. We aim to review and analyze the available data for TAVR in BAV patients, targeting procedural outcomes, clinical outcomes and mortality with up to two years of follow-up.Methods: A literature search of five databases was performed and all primary studies published between 2002 and 2021 that reported procedural, clinical or mortality outcome data were identified. Following data extraction, a meta-analysis of means or proportions was performed using a random effects model. Heterogeneity was assessed using the I 2 statistic.Results: A total of 22 studies with 1,945 BAV patients were identified. The mean age was 74.1 years and 58.8% of patients were male. Device success rates was 87.5%. Moderate to severe paravalvular leak (PVL) was seen in 3.7% of procedures. Clinical outcomes included new permanent pacemaker insertion (PPI) (11.8%), major bleeding (3.5%), major vascular complications (2.5%), stroke (2.3%), acute kidney injury (2.1%) and coronary obstruction (0.1%). Mortality in hospital, at 30-days, one and two years of follow-up were 1.9%, 2.1%, 9.6% and 12.9%, respectively.Conclusions: This assessment of the available data on TAVR for BAV shows promising outcomes and low rates of complications. However, further research is warranted to reduce the heterogeneity of the available data and provide insight into outcomes beyond two years of follow-up.

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Section: Resultsmentioning

confidence: 99%

Section: All-cause Mortalitymentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Procedural and clinical outcomes of transcatheter aortic valve replacement in bicuspid aortic valve patients: a systematic review and meta-analysis

Chen¹,

Jiang²,

Martin³

et al. 2022

Ann Cardiothorac Surg

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“…The study flow is presented as the PRISMA 2020 flow diagram ( Figure 1 ). A total of 22 studies (2,546 patients with BAV) were included for the analysis of BAV phenotypes ( 8 , 10 , 18 – 37 ). A total of 35 studies (including 139,058 patients: 15,700 BAV and 123,358 TAV) were analyzed for comparisons between BAV and TAV ( 7 – 10 , 15 , 18 – 30 , 38 – 54 ), while 10 studies (including 1,294 patients: 805 BE and 489 SE) were analyzed for the difference of BE vs.…”

Section: Resultsmentioning

confidence: 99%

Patients With Bicuspid Aortic Stenosis Undergoing Transcatheter Aortic Valve Replacement: A Systematic Review and Meta-Analysis

Zhang

Xiong

et al. 2022

Front. Cardiovasc. Med.

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ObjectiveWe sought to conduct a systematic review and meta-analysis of clinical adverse events in patients undergoing transcatheter aortic valve replacement (TAVR) with bicuspid aortic valve (BAV) vs. tricuspid aortic valve (TAV) anatomy and the efficacy of balloon-expandable (BE) vs. self-expanding (SE) valves in the BAV population. Comparisons aforementioned will be made stratified into early- and new-generation devices. Differences of prosthetic geometry on CT between patients with BAV and TAV were presented. In addition, BAV morphological presentations in included studies were summarized.MethodObservational studies and a randomized controlled trial of patients with BAV undergoing TAVR were included according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline.ResultsA total of 43 studies were included in the final analysis. In patients undergoing TAVR, type 1 BAV was the most common phenotype and type 2 BAV accounted for the least. Significant higher risks of conversion to surgical aortic valve replacement (SAVR), the need of a second valve, a moderate or severe paravalvular leakage (PVL), device failure, acute kidney injury (AKI), and stroke were observed in patients with BAV than in patients with TAV during hospitalization. BAV had a higher risk of new permanent pacemaker implantation (PPI) both at hospitalization and a 30-day follow-up. Risk of 1-year mortality was significantly lower in patients with BAV than that with TAV [odds ratio (OR) = 0.85, 95% CI 0.75–0.97, p = 0.01]. BE transcatheter heart valves (THVs) had higher risks of annular rupture but a lower risk of the need of a second valve and a new PPI than SE THVs. Moreover, BE THV was less expanded and more elliptical in BAV than in TAV. In general, the rates of clinical adverse events were lower in new-generation THVs than in early-generation THVs in both BAV and TAV.ConclusionsDespite higher risks of conversion to SAVR, the need of a second valve, moderate or severe PVL, device failure, AKI, stroke, and new PPI, TAVR seems to be a viable option for selected patients with severe bicuspid aortic stenosis (AS), which demonstrated a potential benefit of 1-year survival, especially among lower surgical risk population using new-generation devices. Larger randomized studies are needed to guide patient selection and verified the durable performance of THVs in the BAV population.

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“…However, BAVs, particularly Sievers type 0 valves, were uncommon in this study. According to Husso et al [ 45 ], BAVs of type 1 N-L and type 2 L-R/R-N morphologies have significantly higher incidences of mild-to-severe PVL (37.5% and 100%, respectively) than other types of BAVs.…”

Section: Tavr For All?—current Challenges: Bicuspid Aortic Valvementioning

confidence: 99%

TAVR for All? The Surgical Perspective

Zhang

Puehler

Frank³

et al. 2022

JCDD

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In spite of the noninferiority of transcatheter aortic valve replacement (TAVR) in high- and intermediate-risk patients, there are still obstacles that need to be overcome before the procedure is further expanded and clinically integrated. The lack of evidence on the long-term durability of the bioprostheses used for TAVR remains of particular concern. In addition, surgery may be preferred over TAVR in patients with bicuspid aortic valve (BAV) or with concomitant pathologies such as other valve diseases (mitral regurgitation/tricuspid regurgitation), aortopathy, and coronary artery disease. In this review, we discuss and summarize relevant data from clinical trials, current trends, and remaining obstacles, and provide our perspective on the indications for the expansion of TAVR.

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Transcatheter and surgical aortic valve replacement in patients with bicuspid aortic valve

Cited by 21 publications

References 34 publications

Procedural and clinical outcomes of transcatheter aortic valve replacement in bicuspid aortic valve patients: a systematic review and meta-analysis

Procedural and clinical outcomes of transcatheter aortic valve replacement in bicuspid aortic valve patients: a systematic review and meta-analysis

Patients With Bicuspid Aortic Stenosis Undergoing Transcatheter Aortic Valve Replacement: A Systematic Review and Meta-Analysis

TAVR for All? The Surgical Perspective

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