title: Comparison of one- and 12-month outcomes of transcatheter aortic valve replacement in patients with severely stenotic bicuspid versus tricuspid aortic valves (results from a multicenter registry).
abstract: The aim of the study was to evaluate the transcatheter aortic valve replacement (TAVR) in high-risk patients with severe bicuspid aortic valve (BAV) stenosis and to compare the outcomes with a matched group of patients with tricuspid aortic valve. TAVR became an alternative treatment method in high-risk patients with symptomatic aortic stenosis; however, BAV stenosis is regarded as a relative contraindication to TAVR. The study population comprised 28 patients with BAV who underwent TAVR. BAV was diagnosed based on a transesophageal echocardiography. CoreValve and Edwards SAPIEN prostheses were implanted. The control group consisted of 84 patients (3:1 matching) with significant tricuspid aortic valve stenosis treated with TAVR. There were no significant differences between patients with and without BAV in device success (93% vs 93%, p = 1.0), risk of annulus rupture (0% in both groups), or conversion to cardiosurgery (4% vs 0%, respectively, p = 0.25). The postprocedural mean pressure gradient (11.5 ± 6.4 vs 10.4 ± 4.5 mm Hg, p = 0.33), aortic regurgitation grade ≥2 of 4 (32% vs 23%, p = 0.45), 30-day mortality (4% vs 7%, p = 0.68), and 1-year all-cause mortality (19% vs 18%, p = 1.00) did not differ between the groups. Echocardiography showed well-functioning valve prosthesis with a mean prosthetic valve area of 1.6 ± 0.4 cm(2) versus 1.7 ± 0.3 cm(2) (p = 0.73), a mean pressure gradient of 10.3 ± 5.4 versus 9.8 ± 2.8 mm Hg (p = 0.64), and aortic regurgitation grade ≥2 of 4 (22% vs 22%, p = 1.00) for the 2 groups. In conclusion, selected high-risk patients with BAV can be successfully treated with TAVR, and their outcomes are similar to those reported in patients without BAV.
authors.affiliation: First Department of Cardiology, Medical University of Warsaw, Warsaw, Poland. Electronic address: jkochman@wum.edu.pl.
authors.forename: Janusz
authors.initials: J
authors.lastname: Kochman
authors.affiliation: First Department of Cardiology, Medical University of Warsaw, Warsaw, Poland.
authors.forename: Zenon
authors.initials: Z
authors.lastname: Huczek
authors.affiliation: First Department of Cardiology, Medical University of Warsaw, Warsaw, Poland.
authors.forename: Piotr
authors.initials: P
authors.lastname: Scisło
authors.affiliation: Department of Interventional Cardiology and Angiology, Institute of Cardiology, Warsaw, Poland.
authors.forename: Maciej
authors.initials: M
authors.lastname: Dabrowski
authors.affiliation: Department of Interventional Cardiology and Angiology, Institute of Cardiology, Warsaw, Poland.
authors.forename: Zbigniew
authors.initials: Z
authors.lastname: Chmielak
authors.affiliation: Department of Acquired Cardiac Defects, Institute of Cardiology, Warsaw, Poland.
authors.forename: Piotr
authors.initials: P
authors.lastname: Szymański
authors.affiliation: Department of Interventional Cardiology and Angiology, Institute of Cardiology, Warsaw, Poland.
authors.forename: Adam
authors.initials: A
authors.lastname: Witkowski
authors.affiliation: 3rd Division of Cardiology, Medical University of Silesia, Katowice, Poland.
authors.forename: Radosław
authors.initials: R
authors.lastname: Parma
authors.affiliation: 3rd Division of Cardiology, Medical University of Silesia, Katowice, Poland.
authors.forename: Andrzej
authors.initials: A
authors.lastname: Ochala
authors.affiliation: Department of Cardiology, Congenital Heart Disease and Electrotherapy, Silesian Center for Heart Diseases, Medical University of Silesia, Zabrze, Poland.
authors.forename: Piotr
authors.initials: P
authors.lastname: Chodór
authors.affiliation: Department of Cardiology, Congenital Heart Disease and Electrotherapy, Silesian Center for Heart Diseases, Medical University of Silesia, Zabrze, Poland.
authors.forename: Krzysztof
authors.initials: K
authors.lastname: Wilczek
authors.affiliation: Department of Cardiology, Military Hospital, Wroclaw, Poland.
authors.forename: Krzysztof W
authors.initials: KW
authors.lastname: Reczuch
authors.affiliation: Department of Cardiology, Military Hospital, Wroclaw, Poland.
authors.forename: Piotr
authors.initials: P
authors.lastname: Kubler
authors.affiliation: First Department of Cardiology, Medical University of Warsaw, Warsaw, Poland.
authors.forename: Bartosz
authors.initials: B
authors.lastname: Rymuza
authors.affiliation: First Department of Cardiology, Medical University of Warsaw, Warsaw, Poland.
authors.forename: Lukasz
authors.initials: L
authors.lastname: Kołtowski
authors.affiliation: First Department of Cardiology, Medical University of Warsaw, Warsaw, Poland.
authors.forename: Anna
authors.initials: A
authors.lastname: Scibisz
authors.affiliation: First Department of Cardiac Surgery, Medical University of Warsaw, Warsaw, Poland.
authors.forename: Radosław
authors.initials: R
authors.lastname: Wilimski
authors.affiliation: Heart Center, University of Bonn, Bonn, Germany.
authors.forename: Eberhard
authors.initials: E
authors.lastname: Grube
authors.affiliation: First Department of Cardiology, Medical University of Warsaw, Warsaw, Poland.
authors.forename: Grzegorz
authors.initials: G
authors.lastname: Opolski
mesh_terms: D000368:Aged; D001021:Aortic Valve / Q000002:abnormalities* / Q000000981:diagnostic imaging / Q000601:surgery; D001024:Aortic Valve Stenosis / Q000000981:diagnostic imaging / Q000601:surgery*; D000082882:Bicuspid Aortic Valve Disease; D006328:Cardiac Catheterization; D017548:Echocardiography, Transesophageal; D005260:Female; D005500:Follow-Up Studies; D006349:Heart Valve Diseases / Q000000981:diagnostic imaging / Q000601:surgery*; D019918:Heart Valve Prosthesis Implantation / Q000379:methods*; D006801:Humans; D008297:Male; D012042:Registries; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome