title: Transcatheter aortic valve replacement in bicuspid aortic valve disease.
abstract: BACKGROUND
  Limited information exists describing the results of transcatheter aortic valve (TAV) replacement in patients with bicuspid aortic valve (BAV) disease (TAV-in-BAV).
  
  
  OBJECTIVE
  This study sought to evaluate clinical outcomes of a large cohort of patients undergoing TAV-in-BAV.
  
  
  METHODS
  We retrospectively collected baseline characteristics, procedural data, and clinical follow-up findings from 12 centers in Europe and Canada that had performed TAV-in-BAV.
  
  
  RESULTS
  A total of 139 patients underwent TAV-in-BAV with the balloon-expandable transcatheter heart valve (THV) (n = 48) or self-expandable THV (n = 91) systems. Patient mean age and Society of Thoracic Surgeons predicted risk of mortality scores were 78.0 ± 8.9 years and 4.9 ± 3.4%, respectively. BAV stenosis occurred in 65.5%, regurgitation in 0.7%, and mixed disease in 33.8% of patients. Incidence of type 0 BAV was 26.7%; type 1 BAV was 68.3%; and type 2 BAV was 5.0%. Multislice computed tomography (MSCT)-based TAV sizing was used in 63.5% of patients (77.1% balloon-expandable THV vs. 56.0% self-expandable THV, p = 0.02). Procedural mortality was 3.6%, with TAV embolization in 2.2% and conversion to surgery in 2.2%. The mean aortic gradient decreased from 48.7 ± 16.5 mm Hg to 11.4 ± 9.9 mm Hg (p < 0.0001). Post-implantation aortic regurgitation (AR) grade ≥ 2 occurred in 28.4% (19.6% balloon-expandable THV vs. 32.2% self-expandable THV, p = 0.11) but was prevalent in only 17.4% when MSCT-based TAV sizing was performed (16.7% balloon-expandable THV vs. 17.6% self-expandable THV, p = 0.99). MSCT sizing was associated with reduced AR on multivariate analysis (odds ratio [OR]: 0.19, 95% confidence intervals [CI]: 0.08 to 0.45; p < 0.0001). Thirty-day device safety, success, and efficacy were noted in 79.1%, 89.9%, and 84.9% of patients, respectively. One-year mortality was 17.5%. Major vascular complications were associated with increased 1-year mortality (OR: 5.66, 95% CI: 1.21 to 26.43; p = 0.03).
  
  
  CONCLUSIONS
  TAV-in-BAV is feasible with encouraging short- and intermediate-term clinical outcomes. Importantly, a high incidence of post-implantation AR is observed, which appears to be mitigated by MSCT-based TAV sizing. Given the suboptimal echocardiographic results, further study is required to evaluate long-term efficacy.
authors.affiliation: Department of Cardiology, University Hospital Galway, Galway, Ireland; Division of Cardiology, McGill University Health Centre, Montreal, Quebec, Canada.
authors.forename: Darren
authors.initials: D
authors.lastname: Mylotte
authors.affiliation: Department of Interventional Cardiology, Hopital Jacques Cartier, Massy, France.
authors.forename: Thierry
authors.initials: T
authors.lastname: Lefevre
authors.affiliation: Department of Cardiology, Rigshospitalet, Copenhagen, Denmark.
authors.forename: Lars
authors.initials: L
authors.lastname: Søndergaard
authors.affiliation: Department of Interventional Cardiology, Hopital Jacques Cartier, Massy, France.
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Watanabe
authors.affiliation: Department of Cardiovascular Surgery, Hôpital Cardiologique, Lille, France.
authors.forename: Thomas
authors.initials: T
authors.lastname: Modine
authors.affiliation: Department of Cardiology, St. Paul's Hospital, Vancouver, British Columbia, Canada.
authors.forename: Danny
authors.initials: D
authors.lastname: Dvir
authors.affiliation: Department of Cardiology, University Hospital Antwerp, Wilrijk, Belgium.
authors.forename: Johan
authors.initials: J
authors.lastname: Bosmans
authors.affiliation: Department of Interventional Cardiology, Clinique Pasteur, Toulouse, France.
authors.forename: Didier
authors.initials: D
authors.lastname: Tchetche
authors.affiliation: Department of Cardiology, Rabin Medical Center and Tel-Aviv University, Tel-Aviv, Israel.
authors.forename: Ran
authors.initials: R
authors.lastname: Kornowski
authors.affiliation: Division of Cardiology, McGill University Health Centre, Montreal, Quebec, Canada; Department of Interventional Cardiology, Hopital Jacques Cartier, Massy, France.
authors.forename: Jan-Malte
authors.initials: JM
authors.lastname: Sinning
authors.affiliation: Division of Cardiology, McGill University Health Centre, Montreal, Quebec, Canada.
authors.forename: Pascal
authors.initials: P
authors.lastname: Thériault-Lauzier
authors.affiliation: Department of Cardiology, Bern University Hospital, Bern, Switzerland.
authors.forename: Crochan J
authors.initials: CJ
authors.lastname: O'Sullivan
authors.affiliation: Department of Cardiology, Ferrarotto Hospital, University of Catania, Catania, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Barbanti
authors.affiliation: Department of Cardiovascular Surgery, Hôpital Cardiologique, Lille, France.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Debry
authors.affiliation: Division of Cardiology, McGill University Health Centre, Montreal, Quebec, Canada.
authors.forename: Jean
authors.initials: J
authors.lastname: Buithieu
authors.affiliation: Department of Cardiology, Rabin Medical Center and Tel-Aviv University, Tel-Aviv, Israel.
authors.forename: Pablo
authors.initials: P
authors.lastname: Codner
authors.affiliation: Department of Cardiovascular Surgery, German Heart Center, Munich, Germany.
authors.forename: Magdalena
authors.initials: M
authors.lastname: Dorfmeister
authors.affiliation: Division of Cardiology, McGill University Health Centre, Montreal, Quebec, Canada.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Martucci
authors.affiliation: Department of Cardiology, Universitätsklinikum Bonn, Rheinische Friedrich-Wilhelms-Universität Bonn, Bonn, Germany.
authors.forename: Georg
authors.initials: G
authors.lastname: Nickenig
authors.affiliation: Department of Cardiology, Bern University Hospital, Bern, Switzerland.
authors.forename: Peter
authors.initials: P
authors.lastname: Wenaweser
authors.affiliation: Department of Cardiology, Ferrarotto Hospital, University of Catania, Catania, Italy.
authors.forename: Corrado
authors.initials: C
authors.lastname: Tamburino
authors.affiliation: Department of Cardiology, Universitätsklinikum Bonn, Rheinische Friedrich-Wilhelms-Universität Bonn, Bonn, Germany.
authors.forename: Eberhard
authors.initials: E
authors.lastname: Grube
authors.affiliation: Department of Cardiology, St. Paul's Hospital, Vancouver, British Columbia, Canada.
authors.forename: John G
authors.initials: JG
authors.lastname: Webb
authors.affiliation: Department of Cardiology, Bern University Hospital, Bern, Switzerland.
authors.forename: Stephan
authors.initials: S
authors.lastname: Windecker
authors.affiliation: Department of Cardiovascular Surgery, German Heart Center, Munich, Germany.
authors.forename: Ruediger
authors.initials: R
authors.lastname: Lange
authors.affiliation: Division of Cardiology, McGill University Health Centre, Montreal, Quebec, Canada; Department of Cardiovascular Surgery, German Heart Center, Munich, Germany. Electronic address: nicolopiazza@mac.com.
authors.forename: Nicolo
authors.initials: N
authors.lastname: Piazza
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000002:abnormalities* / Q000601:surgery; D001024:Aortic Valve Stenosis / Q000175:diagnosis* / Q000601:surgery*; D000082882:Bicuspid Aortic Valve Disease; D015331:Cohort Studies; D005260:Female; D006349:Heart Valve Diseases / Q000175:diagnosis* / Q000601:surgery*; D006801:Humans; D008297:Male; D011446:Prospective Studies; D012042:Registries; D012189:Retrospective Studies; D065467:Transcatheter Aortic Valve Replacement / Q000379:methods*; D016896:Treatment Outcome
keywords: aortic stenosis; aortic valve replacement; bicuspid aortic valve; transcatheter aortic valve implantation; transcatheter aortic valve replacement