Annular size and interaction with trans-catheter aortic valves for treatment of severe bicuspid aortic valve stenosis: Insights from the BEAT registry.

Aortic Valve / diagnostic imaging Aortic Valve Stenosis / diagnostic imaging Bicuspid Aortic Valve Disease Catheters Constriction, Pathologic Heart Valve Prosthesis Humans Male Prosthesis Design Registries Stroke Volume Transcatheter Aortic Valve Replacement Treatment Outcome Ventricular Function, Left

Annulus dimensions Balloon expandable valves Bicuspid aortic valve Self-expanding valve Severe aortic stenosis Trans-catheter valve replacement

Journal

International journal of cardiology

ISSN: 1874-1754

Titre abrégé: Int J Cardiol

Pays: Netherlands

ID NLM: 8200291

Informations de publication

Date de publication:
15 Feb 2022

Historique:

received: 07 10 2021

revised: 15 11 2021

accepted: 24 11 2021

pubmed: 30 11 2021

medline: 27 1 2022

entrez: 29 11 2021

Statut: ppublish

Résumé

Transcatheter aortic valve replacement (TAVR) is safe and feasible in patients with bicuspid aortic valve (BAV), but whether annular size may influence TAVR results in BAV patients remains unclear. We aimed at evaluating the impact of aortic annular size on procedural and clinical outcomes of BAV patients undergoing TAVR, as well as potential interactions between annular dimension and trans-catheter heart valve (THV) type (balloon-expandable (BEV) vs. self-expanding (SEV). BEAT is a multicenter registry of consecutive BAV stenosis undergoing TAVR. For this sub-study patients were classified according to annular dimension in small-annulus (area < 400 mm 45(15.5%) patients had small, 132(45.3%) medium, and 114(39.2%) large annuli. Compared with other groups, patients with large annuli were more frequently male, younger, with higher body mass index, larger aortic valve area, higher rate of moderate-severe calcification, lower mean trans-aortic valve gradient and lower left ventricular ejection fraction. In large-annuli SEVs were associated with a lower VARC-2 device success (75.9% vs. 90.6%, p = 0.049) driven by a higher rate of paravalvular valvular leak (PVL) compared to BEVs (20.7% vs. 1.2%, p < 0.001). However, no differences in clinical outcomes were observed according to annular size nor THV type. TAVR in BAV patients is feasible irrespective of annular size. However in patients with large aortic annulus SEVs were associated with a significantly higher rate of PVLs compared to BEVs.

Sections du résumé

BACKGROUND BACKGROUND

METHODS METHODS

BEAT is a multicenter registry of consecutive BAV stenosis undergoing TAVR. For this sub-study patients were classified according to annular dimension in small-annulus (area < 400 mm

RESULTS RESULTS

45(15.5%) patients had small, 132(45.3%) medium, and 114(39.2%) large annuli. Compared with other groups, patients with large annuli were more frequently male, younger, with higher body mass index, larger aortic valve area, higher rate of moderate-severe calcification, lower mean trans-aortic valve gradient and lower left ventricular ejection fraction. In large-annuli SEVs were associated with a lower VARC-2 device success (75.9% vs. 90.6%, p = 0.049) driven by a higher rate of paravalvular valvular leak (PVL) compared to BEVs (20.7% vs. 1.2%, p < 0.001). However, no differences in clinical outcomes were observed according to annular size nor THV type.

CONCLUSIONS CONCLUSIONS

TAVR in BAV patients is feasible irrespective of annular size. However in patients with large aortic annulus SEVs were associated with a significantly higher rate of PVLs compared to BEVs.

Identifiants

DOI: 10.1016/j.ijcard.2021.11.055 PMID: 34843819

pubmed: 34843819

pii: S0167-5273(21)01871-4

doi: 10.1016/j.ijcard.2021.11.055

pii:

doi:

Types de publication

Journal Article Multicenter Study

Langues

eng

Sous-ensembles de citation

Pagination

31-38

Commentaires et corrections

Type : CommentIn