Author + information
- Received September 14, 2015
- Revision received November 25, 2015
- Accepted December 10, 2015
- Published online October 1, 2016.
- Hasan Jilaihawi, MDa,∗ (, )
- Mao Chen, MDb,
- John Webb, MDc,
- Dominique Himbert, MDd,
- Carlos E. Ruiz, MDe,
- Josep Rodés-Cabau, MDf,
- Gregor Pache, MDg,
- Antonio Colombo, MDh,
- Georg Nickenig, MDi,
- Michael Lee, MDj,
- Corrado Tamburino, MDk,
- Horst Sievert, MDl,
- Yigal Abramowitz, MDm,
- Giuseppe Tarantini, MDn,
- Faisal Alqoofi, MDo,
- Tarun Chakravarty, MDm,
- Mohammad Kashif, MDm,
- Nobuyuki Takahashi, MDm,
- Yoshio Kazuno, MDm,
- Yoshio Maeno, MDm,
- Hiroyuki Kawamori, MDm,
- Alaide Chieffo, MDh,
- Philipp Blanke, MDc,g,
- Danny Dvir, MDc,
- Henrique Barbosa Ribeiro, MDf,
- Yuan Feng, MDb,
- Zhen-Gang Zhao, MDb,
- Jan-Malte Sinning, MDi,
- Chad Kliger, MDe,
- Gennaro Giustino, MDh,
- Basia Pajerski, MDc,
- Sebastiano Imme, MDk,
- Eberhard Grube, MDi,
- Jonathon Leipsic, MDc,
- Alec Vahanian, MDd,
- Iassen Michev, MDh,
- Vladimir Jelnin, MDe,
- Azeem Latib, MDh,
- Wen Cheng, MDm and
- Raj Makkar, MDm
- aDepartment of Cardiology and Cardiothoracic Surgery, NYU Langone Medical Center, New York, New York
- bDepartment of Cardiology, West China Hospital, Sichuan University, Chengdu, China
- cSt. Paul's Hospital, Vancouver, Canada
- dDepartment of Cardiology, Assistance Publique-Hôpitaux de Paris, Bichat-Claude Bernard Hospital, Paris, France
- eLenox Hill Heart and Vascular Institute of New York, New York, New York
- fQuebec Heart and Lung Institute, Laval University, Quebec City, Canada
- gUniversity Hospital Freiburg, Freiburg, Germany
- hEMO-GVM Centro Cuore Columbus and San Raffaele Scientific Institute, Milan, Italy
- iDepartment of Internal Medicine and Cardiology/Pneumology, University of Bonn, Bonn, Germany
- jDivision of Cardiology, Department of Medicine, Queen Elizabeth Hospital, Kowloon, Hong Kong
- kFerrarotto Hospital, University of Catania, Catania, Italy
- lDepartment of Cardiology and Vascular Medicine, CardioVasculäres Centrum Frankfurt, Frankfurt, Germany
- mCedars-Sinai Heart Institute, Los Angeles, California
- nUniversity of Padua, Padua, Italy
- oUniversity of Calgary, Calgary, Canada
- ↵∗Reprint requests and correspondence:
Dr. Hasan Jilaihawi, Cedars-Sinai Heart Institute, Suite A3600, 127 South San Vicente Boulevard, Los Angeles, California 20037.
Objectives This study sought to evaluate transcatheter aortic valve replacement (TAVR) in bicuspid aortic valve (BAV) aortic stenosis (AS), with a particular emphasis on TAVR-directed bicuspid aortic valve imaging (BAVi) of morphological classification.
Background TAVR has been used to treat BAV-AS but with heterogeneous outcomes and uncertainty regarding the relevance of morphology.
Methods In 14 centers in the United States, Canada, Europe, and Asia, 130 BAV-AS patients underwent TAVR. Baseline cardiac computed tomography (CT) was analyzed by a dedicated Corelab. Outcomes were assessed in line with Valve Academic Research Consortium criteria.
Results Bicommissural BAV (vs. tricommissural) accounted for 68.9% of those treated in North America, 88.9% in Europe, and 95.5% in Asia (p = 0.003). For bicommissural bicuspids, non-raphe type (vs. raphe type) BAV accounted for 11.9% of those treated in North America, 9.4% in Europe, and 61.9% in Asia (p < 0.001). Overall rates of 30-day mortality (3.8%) and cerebrovascular events (3.2%) were favorable and similar among anatomical subsets. The rate of new permanent pacemaker insertion was high (26.2%) and similar between balloon-expandable (BE) and self-expanding (SE) designs (BE: 25.5% vs. SE: 26.9%; p = 0.83); there was a trend to greater permanent pacemaker insertion in BE TAVR in the presence of coronary cusp fusion BAV morphology. Paravalvular aortic regurgitation (PAR) ≥ moderate was 18.1% overall but lower at 11.5% in those with pre-procedural CT. In the absence of pre-procedural CT, there was an excess of PAR in BE TAVR that was not the case in those with a pre-procedural CT; SE TAVR required more post-dilation. Predictors of PAR included intercommissural distance for bicommissural bicuspids (odd ratio [OR]: 1.37; 95% confidence interval [CI]: 1.02 to 1.84; p = 0.036) and lack of a baseline CT for annular measurement (OR: 3.03; 95% CI: 1.20 to 7.69; p = 0.018).
Conclusions In this multicenter study, TAVR achieved favorable outcomes in patients with pre-procedural CT, with the exception of high permanent pacemaker rates for all devices and shapes.
- aortic stenosis
- aortic valve replacement
- bicuspid aortic valve
- transcatheter aortic valve implantation
- transcatheter aortic valve replacement
Dr. Jilaihawi is a consultant for Edwards Lifesciences, St. Jude Medical, Venus, and Medtech. Dr. Makkar has received grants from Edwards Lifesciences; and personal fees from St. Jude Medical and Medtronic. Dr. Webb is a consultant for Edwards Lifesciences. Dr. Himbert is a consultant and proctor for Edwards Lifesciences and Medtronic. Dr. Ruiz has a financial relationship with Philips and St. Jude Medical; and has received educational grant(s) from Philips Healthcare. Dr. Sievert has received fees for consulting and travel and honoraria from Abbott, Access Closure, AGA, Angiomed, Aptus, Atrium, Avinger, Bard, Boston Scientific, Bridgepoint, Carag, Cardiac Dimensions, CardioKinetix, CardioMEMS, Cardiox, Celonova, CGuard, Coherex, Contego, Covidien, CSI, CVRx, EndoCross, ev3, FlowCardia, Gardia, Gore, Guided Delivery Systems, Hemoteq, InSeal Medical, Lumen Biomedical, HLT, Lifetech, Lutonix, Maya Medical, Medtronic, NDC, Occlutech, Osprey, Ostial, PendraCare, pfm Medical, Recor, ResMed, Rox Medical, SentreHeart, Spectranetics, SquareOne, Svelte Medical Systems, Trireme, Trivascular, Vascular Dynamics, Venus Medical, Veryan, and Vessix; owns stock options in Cardiokinetix, Access Closure, Velocimed, Lumen Biomedical, Coherex, and SMT; and has received grants from Cook and St. Jude Medical. Dr. Blanke is a consultant for Edwards Lifesciences, Neovasc, Tendyne, and Consultant Circle Imaging. Dr. Sinning has received honoraria from Medtronic, Edwards Lifesciences, Abbott, Direct Flow Medical; and has received research grants from Medtronic, Edwards Lifesciences, and Boston Scientific. Dr. Kliger has financial relationships with St. Jude Medical and Philips Healthcare. Dr. Leipsic has financial relationships with Edwards Lifesciences and Circl CVI. Dr. Vahanian has received honoraria from Abbott Vascular, Edwards Lifesciences, and Valtech. Dr. Michev is a proctor for Medtronic Corevalve and Boston Scientific. Dr. Latib is a consultant for Medtronic and Direct Flow Medical. Dr. Makkar is a consultant for Abbott Vascular, Cordis, and Medtronic; and has received grants from Edwards Lifesciences and St. Jude Medical. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received September 14, 2015.
- Revision received November 25, 2015.
- Accepted December 10, 2015.
- American College of Cardiology Foundation