title: Transcatheter aortic valve implantation in patients with bicuspid aortic valve: a series of cases.
abstract: BACKGROUND
  Bicuspid aortic valve (BAV) has been considered a relative contraindication for transcatheter aortic valve implantation (TAVI). Due to more oval shape of the BAV annulus compared to tricuspid aortic valve, the procedure has been discouraged because of an increased risk of stent assembly displacement, uneven expansion, post-procedure paravalvular leakage, stent valve distortion, or other malfunction after implantation. For the same reasons patients with BAV have been excluded from the majority of clinical TAVI trials.
  
  
  OBJECTIVE
  To evaluate the efficacy and safety of TAVI in patients with BAV stenosis.
  
  
  METHODS
  We analysed a group of 104 patients admitted to our institution for TAVI between January 2009 and May 2012. During pre-procedure evaluation, transthoracic and transoesophageal (TEE) echocardiography as well as angio-computed tomography (CT) scan were performed to assess aortic valve anatomy and morphology. Appropriate measurements and detailed analyses of imaging data have been accomplished to select optimal access site, prosthesis size as well as to plan the procedure. BAVs were recorded in seven patients (6.7%; mean age 77.7 years). These patients presented with severe symptomatic aortic valve stenosis with a mean aortic valve area of 0.55 cm² (0.46-0.7 cm²) as measured in TEE. All of the patients had been disqualified from surgical valve replacement due to high surgical risk with a mean logistic Euroscore of 19.9%. All of them successfully underwent TAVI using CoreValve (n = 5) or Sapien (n = 2) valves. Follow-up was completed at 30 days, and six and 12 months after the procedure.
  
  
  RESULTS
  During follow-up one patient developed an elliptic distortion of the aortic prosthesis in CT, although it did not result in significant malfunctioning of the implant. One patient died of infective endocarditis 30 days after the procedure. Survivors at 30-day follow-up had mild to moderate aortic insufficiency, and it did not deteriorate after six months. At one year follow-up six out of seven patients remained alive. They achieved significant functional improvement by New York Heart Association class compared to baseline.
  
  
  CONCLUSIONS
  TAVI may constitute an alternative treatment option for high-risk patients with BAV, resulting in a low periprocedural mortality rate, and good 30-day, six-month, and one-year outcomes.
authors: Department of Interventional Cardiology and Angiology, Institute of Cardiology, Warsaw, Poland. mkosek@ikard.pl.
authors: Mikołaj
authors: M
authors: Kosek
authors: Adam
authors: A
authors: Witkowski
authors: Maciej
authors: M
authors: Dąbrowski
authors: Jan
authors: J
authors: Jastrzębski
authors: Ilona
authors: I
authors: Michałowska
authors: Zbigniew
authors: Z
authors: Chmielak
authors: Marcin
authors: M
authors: Demkow
authors: Ewa
authors: E
authors: Księżycka-Majczyńska
authors: Piotr
authors: P
authors: Michałek
authors: Piotr
authors: P
authors: Szymański
authors: Tomasz
authors: T
authors: Hryniewiecki
authors: Janina
authors: J
authors: Stępińska
authors: Ewa
authors: E
authors: Sitkowska-Rysiak
authors: Witold
authors: W
authors: Rużyłło
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000002:abnormalities* / Q000000981:diagnostic imaging / Q000601:surgery; D000082882:Bicuspid Aortic Valve Disease; D005260:Female; D006349:Heart Valve Diseases / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D065467:Transcatheter Aortic Valve Replacement; D016896:Treatment Outcome