title: Transcatheter aortic valve implantation in patients with bicuspid aortic valve stenosis.
abstract: OBJECTIVE
  We evaluated transcatheter aortic valve implantation (TAVI) in high-risk patients with bicuspid aortic valve (BAV) stenosis.
  
  
  BACKGROUND
  TAVI shows promise in the treatment of severe stenosis of triscupid aortic valves, especially in high-risk patients. However, BAV stenosis has been considered a contraindication to TAVI.
  
  
  METHODS
  Eleven patients (age 52 to 90 years) with symptomatic severe BAV stenosis underwent TAVI at 3 Canadian tertiary hospitals between May 2006 and April 2010. All patients were considered high risk for surgical aortic valve replacement. Edwards-SAPIEN transcatheter heart valves (Edwards Lifesciences, Inc., Irvine, California) were used. Transfemoral or transapical access was selected, depending on the adequacy of femoral access.
  
  
  RESULTS
  Access was transfemoral in 7 patients and transapical in 4 patients. There were no intraprocedural complications. Significant symptomatic and hemodynamic improvement was observed in 10 of 11 patients. Baseline aortic valve area of 0.65 ± 0.17 cm(2) and mean transaortic pressure gradient of 41 ± 22.4 mm Hg were improved to 1.45 ± 0.3 cm(2) and 13.4 ± 5.7 mm Hg, respectively. Two patients had moderate perivalvular leaks. At the 30-day follow-up there were 2 deaths due to multisystem failure in 2 transapical patients. In 1 patient an undersized, suboptimally positioned, unstable valve required late conversion to open surgery.
  
  
  CONCLUSIONS
  TAVI in selected high-risk patients with severe BAV stenosis can be successfully performed with acceptable clinical outcomes but will require further evaluation.
authors.affiliation: St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Namal
authors.initials: N
authors.lastname: Wijesinghe
authors.forename: Jian
authors.initials: J
authors.lastname: Ye
authors.forename: Josep
authors.initials: J
authors.lastname: Rodés-Cabau
authors.forename: Anson
authors.initials: A
authors.lastname: Cheung
authors.forename: James L
authors.initials: JL
authors.lastname: Velianou
authors.forename: Madhu K
authors.initials: MK
authors.lastname: Natarajan
authors.forename: Eric
authors.initials: E
authors.lastname: Dumont
authors.forename: Fabian
authors.initials: F
authors.lastname: Nietlispach
authors.forename: Ronen
authors.initials: R
authors.lastname: Gurvitch
authors.forename: David A
authors.initials: DA
authors.lastname: Wood
authors.forename: Edgar
authors.initials: E
authors.lastname: Tay
authors.forename: John G
authors.initials: JG
authors.lastname: Webb
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000002:abnormalities* / Q000000981:diagnostic imaging / Q000503:physiopathology; D001024:Aortic Valve Stenosis / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy*; D002170:Canada; D006328:Cardiac Catheterization / Q000295:instrumentation; D017548:Echocardiography, Transesophageal; D005260:Female; D005263:Femoral Artery; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000295:instrumentation / Q000379:methods*; D006439:Hemodynamics; D006801:Humans; D008297:Male; D008875:Middle Aged; D011474:Prosthesis Design; D012720:Severity of Illness Index; D013908:Thoracotomy; D013997:Time Factors; D016896:Treatment Outcome