title: A Bicuspid Aortic Valve Imaging Classification for the TAVR Era.
abstract: 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.
  
  
  
  TAVR has been used to treat BAV-AS but with heterogeneous outcomes and uncertainty regarding the relevance of morphology.
  
  
  
  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.
  
  
  
  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).
  
  
  
  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.
authors.affiliation: Department of Cardiology and Cardiothoracic Surgery, NYU Langone Medical Center, New York, New York. Electronic address: hasanjilaihawi@gmail.com.
authors.forename: Hasan
authors.initials: H
authors.lastname: Jilaihawi
authors.affiliation: Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China.
authors.forename: Mao
authors.initials: M
authors.lastname: Chen
authors.affiliation: St. Paul's Hospital, Vancouver, Canada.
authors.forename: John
authors.initials: J
authors.lastname: Webb
authors.affiliation: Department of Cardiology, Assistance Publique-Hôpitaux de Paris, Bichat-Claude Bernard Hospital, Paris, France.
authors.forename: Dominique
authors.initials: D
authors.lastname: Himbert
authors.affiliation: Lenox Hill Heart and Vascular Institute of New York, New York, New York.
authors.forename: Carlos E
authors.initials: CE
authors.lastname: Ruiz
authors.affiliation: Quebec Heart and Lung Institute, Laval University, Quebec City, Canada.
authors.forename: Josep
authors.initials: J
authors.lastname: Rodés-Cabau
authors.affiliation: University Hospital Freiburg, Freiburg, Germany.
authors.forename: Gregor
authors.initials: G
authors.lastname: Pache
authors.affiliation: EMO-GVM Centro Cuore Columbus and San Raffaele Scientific Institute, Milan, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Colombo
authors.affiliation: Department of Internal Medicine and Cardiology/Pneumology, University of Bonn, Bonn, Germany.
authors.forename: Georg
authors.initials: G
authors.lastname: Nickenig
authors.affiliation: Division of Cardiology, Department of Medicine, Queen Elizabeth Hospital, Kowloon, Hong Kong.
authors.forename: Michael
authors.initials: M
authors.lastname: Lee
authors.affiliation: Ferrarotto Hospital, University of Catania, Catania, Italy.
authors.forename: Corrado
authors.initials: C
authors.lastname: Tamburino
authors.affiliation: Department of Cardiology and Vascular Medicine, CardioVasculäres Centrum Frankfurt, Frankfurt, Germany.
authors.forename: Horst
authors.initials: H
authors.lastname: Sievert
authors.affiliation: Cedars-Sinai Heart Institute, Los Angeles, California.
authors.forename: Yigal
authors.initials: Y
authors.lastname: Abramowitz
authors.affiliation: University of Padua, Padua, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Tarantini
authors.affiliation: University of Calgary, Calgary, Canada.
authors.forename: Faisal
authors.initials: F
authors.lastname: Alqoofi
authors.affiliation: Cedars-Sinai Heart Institute, Los Angeles, California.
authors.forename: Tarun
authors.initials: T
authors.lastname: Chakravarty
authors.affiliation: Cedars-Sinai Heart Institute, Los Angeles, California.
authors.forename: Mohammad
authors.initials: M
authors.lastname: Kashif
authors.affiliation: Cedars-Sinai Heart Institute, Los Angeles, California.
authors.forename: Nobuyuki
authors.initials: N
authors.lastname: Takahashi
authors.affiliation: Cedars-Sinai Heart Institute, Los Angeles, California.
authors.forename: Yoshio
authors.initials: Y
authors.lastname: Kazuno
authors.affiliation: Cedars-Sinai Heart Institute, Los Angeles, California.
authors.forename: Yoshio
authors.initials: Y
authors.lastname: Maeno
authors.affiliation: Cedars-Sinai Heart Institute, Los Angeles, California.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Kawamori
authors.affiliation: EMO-GVM Centro Cuore Columbus and San Raffaele Scientific Institute, Milan, Italy.
authors.forename: Alaide
authors.initials: A
authors.lastname: Chieffo
authors.affiliation: St. Paul's Hospital, Vancouver, Canada; University Hospital Freiburg, Freiburg, Germany.
authors.forename: Philipp
authors.initials: P
authors.lastname: Blanke
authors.affiliation: St. Paul's Hospital, Vancouver, Canada.
authors.forename: Danny
authors.initials: D
authors.lastname: Dvir
authors.affiliation: Quebec Heart and Lung Institute, Laval University, Quebec City, Canada.
authors.forename: Henrique Barbosa
authors.initials: HB
authors.lastname: Ribeiro
authors.affiliation: Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China.
authors.forename: Yuan
authors.initials: Y
authors.lastname: Feng
authors.affiliation: Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China.
authors.forename: Zhen-Gang
authors.initials: ZG
authors.lastname: Zhao
authors.affiliation: Department of Internal Medicine and Cardiology/Pneumology, University of Bonn, Bonn, Germany.
authors.forename: Jan-Malte
authors.initials: JM
authors.lastname: Sinning
authors.affiliation: Lenox Hill Heart and Vascular Institute of New York, New York, New York.
authors.forename: Chad
authors.initials: C
authors.lastname: Kliger
authors.affiliation: EMO-GVM Centro Cuore Columbus and San Raffaele Scientific Institute, Milan, Italy.
authors.forename: Gennaro
authors.initials: G
authors.lastname: Giustino
authors.affiliation: St. Paul's Hospital, Vancouver, Canada.
authors.forename: Basia
authors.initials: B
authors.lastname: Pajerski
authors.affiliation: Ferrarotto Hospital, University of Catania, Catania, Italy.
authors.forename: Sebastiano
authors.initials: S
authors.lastname: Imme
authors.affiliation: Department of Internal Medicine and Cardiology/Pneumology, University of Bonn, Bonn, Germany.
authors.forename: Eberhard
authors.initials: E
authors.lastname: Grube
authors.affiliation: St. Paul's Hospital, Vancouver, Canada.
authors.forename: Jonathon
authors.initials: J
authors.lastname: Leipsic
authors.affiliation: Department of Cardiology, Assistance Publique-Hôpitaux de Paris, Bichat-Claude Bernard Hospital, Paris, France.
authors.forename: Alec
authors.initials: A
authors.lastname: Vahanian
authors.affiliation: EMO-GVM Centro Cuore Columbus and San Raffaele Scientific Institute, Milan, Italy.
authors.forename: Iassen
authors.initials: I
authors.lastname: Michev
authors.affiliation: Lenox Hill Heart and Vascular Institute of New York, New York, New York.
authors.forename: Vladimir
authors.initials: V
authors.lastname: Jelnin
authors.affiliation: EMO-GVM Centro Cuore Columbus and San Raffaele Scientific Institute, Milan, Italy.
authors.forename: Azeem
authors.initials: A
authors.lastname: Latib
authors.affiliation: Cedars-Sinai Heart Institute, Los Angeles, California.
authors.forename: Wen
authors.initials: W
authors.lastname: Cheng
authors.affiliation: Cedars-Sinai Heart Institute, Los Angeles, California.
authors.forename: Raj
authors.initials: R
authors.lastname: Makkar
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000002:abnormalities* / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery; D001024:Aortic Valve Stenosis / Q000145:classification / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000601:surgery*; D001208:Asia; D000082882:Bicuspid Aortic Valve Disease; D002170:Canada; D005060:Europe; D005260:Female; D006349:Heart Valve Diseases / Q000145:classification / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D008297:Male; D061330:Multidetector Computed Tomography; D011237:Predictive Value of Tests; D065467:Transcatheter Aortic Valve Replacement; D016896:Treatment Outcome; D014481:United States
keywords: TAVI; TAVR; aortic stenosis; aortic valve replacement; bicuspid aortic valve; transcatheter aortic valve implantation; transcatheter aortic valve replacement