Outcomes in Transcatheter Aortic Valve Replacement for Bicuspid Versus Tricuspid Aortic Valve Stenosis.
BACKGROUND
Transcatheter aortic valve replacement (TAVR) is being increasingly performed in patients with bicuspid aortic valve stenosis (AS).


OBJECTIVE
This study sought to compare the procedural and clinical outcomes in patients with bicuspid versus tricuspid AS from the Bicuspid AS TAVR multicenter registry.


METHODS
Outcomes of 561 patients with bicuspid AS and 4,546 patients with tricuspid AS were compared after propensity score matching, assembling 546 pairs of patients with similar baseline characteristics. Procedural and clinical outcomes were recorded according to Valve Academic Research Consortium-2 criteria.


RESULTS
Compared with patients with tricuspid AS, patients with bicuspid AS had more frequent conversion to surgery (2.0% vs. 0.2%; p = 0.006) and a significantly lower device success rate (85.3% vs. 91.4%; p = 0.002). Early-generation devices were implanted in 320 patients with bicuspid and 321 patients with tricuspid AS, whereas new-generation devices were implanted in 226 and 225 patients with bicuspid and tricuspid AS, respectively. Within the group receiving early-generation devices, bicuspid AS had more frequent aortic root injury (4.5% vs. 0.0%; p = 0.015) when receiving the balloon-expanding device, and moderate-to-severe paravalvular leak (19.4% vs. 10.5%; p = 0.02) when receiving the self-expanding device. Among patients with new-generation devices, however, procedural results were comparable across different prostheses. The cumulative all-cause mortality rates at 2 years were comparable between bicuspid and tricuspid AS (17.2% vs. 19.4%; p = 0.28).


CONCLUSIONS
Compared with tricuspid AS, TAVR in bicuspid AS was associated with a similar prognosis, but lower device success rate. Procedural differences were observed in patients treated with the early-generation devices, whereas no differences were observed with the new-generation devices.
Department of Interventional Cardiology, Cedars-Sinai Heart Institute, Los Angeles, California. Electronic address: yunsonhan@gmail.com.
Sung-Han
SH
Yoon
Clinic for Cardiovascular Surgery, German Heart Center Munich, Germany.
Sabine
S
Bleiziffer
The Heart Centre, Rigshospitalet University Hospital, Copenhagen, Denmark.
Ole
O
De Backer
Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands.
Victoria
V
Delgado
Générale de Santé, Institut Cardiovasculaire Paris Sud, Hopital Privé Jacques Cartier, Massy, France.
Takahide
T
Arai
Clinic for Cardiovascular Surgery, German Heart Center Munich, Germany.
Johannes
J
Ziegelmueller
Division of Cardiology, Ferrarotto Hospital, University of Catania, Catania, Italy.
Marco
M
Barbanti
Department of Interventional Cardiology, Cedars-Sinai Heart Institute, Los Angeles, California.
Rahul
R
Sharma
Department of Cardiology, St Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada.
Gidon Y
GY
Perlman
Columbia University Medical Center/New York Presbyterian Hospital, New York, New York.
Omar K
OK
Khalique
Heart Center, Segeberger Kliniken GmbH, Academic Teaching Hospital of the Universities of Kiel, Hamburg, and Lübeck, Bad Segeberg, Germany.
Erik W
EW
Holy
Sussex Cardiac Centre, Brighton and Sussex University Hospitals NHS Trust, Brighton, United Kingdom.
Smriti
S
Saraf
Department of General and Interventional Cardiology, University Heart Center, Hamburg, Germany.
Florian
F
Deuschl
Department of Thoracic and Cardiovascular Surgery, Heart and Diabetes Center NRW, Ruhr-University Bochum, Bad Oeynhausen, Germany.
Buntaro
B
Fujita
Department of Cardiology & Angiology II, University Heart Center Freiburg-Bad Krozingen, Bad Krozingen, Germany.
Philipp
P
Ruile
Department of Radiology, Section of Cardiovascular Radiology, University of Freiburg, Bad Krozingen, Germany.
Franz-Josef
FJ
Neumann
Department of Radiology, Section of Cardiovascular Radiology, University of Freiburg, Bad Krozingen, Germany.
Gregor
G
Pache
Department of Cardiology, Henri Mondor University Hospital, Créteil, France.
Masao
M
Takahashi
Heart Center Brandenburg in Bernau, Bernau, Germany.
Hidehiro
H
Kaneko
Department of Cardiology, Asklepios Klink St. Georg, Hamburg, Germany.
Tobias
T
Schmidt
Department of Cardiology, St Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada.
Yohei
Y
Ohno
Department of General and Interventional Cardiology, University Heart Center, Hamburg, Germany.
Niklas
N
Schofer
Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands; Department of Cardiology, National University Heart Centre, Singapore.
William K F
WKF
Kong
Department of Cardiology, National University Heart Centre, Singapore.
Edgar
E
Tay
Department of Preventive Medicine and Public Health, Keio University, Tokyo, Japan.
Daisuke
D
Sugiyama
Department of Interventional Cardiology, Cedars-Sinai Heart Institute, Los Angeles, California.
Hiroyuki
H
Kawamori
Department of Interventional Cardiology, Cedars-Sinai Heart Institute, Los Angeles, California.
Yoshio
Y
Maeno
Department of Interventional Cardiology, Cedars-Sinai Heart Institute, Los Angeles, California.
Yigal
Y
Abramowitz
Department of Interventional Cardiology, Cedars-Sinai Heart Institute, Los Angeles, California.
Tarun
T
Chakravarty
Department of Interventional Cardiology, Cedars-Sinai Heart Institute, Los Angeles, California.
Mamoo
M
Nakamura
University Heart Center, University Hospital Zurich, Zurich, Switzerland.
Shingo
S
Kuwata
Division of Cardiology, Royal Perth Hospital, Perth, Western Australia, Australia.
Gerald
G
Yong
Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
Hsien-Li
HL
Kao
Division of Cardiology, Queen Elizabeth Hospital, Kowloon, Hong Kong.
Michael
M
Lee
Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Korea.
Hyo-Soo
HS
Kim
Department of Cardiovascular Surgery, Hospital Cardiologique, Lille, France.
Thomas
T
Modine
Greenberg Division of Cardiology, New York-Presbyterian Hospital, Weil Cornell Medicine, New York, New York.
S Chiu
SC
Wong
Department of Cardiology, IRCCS Pol San Donato, San Donato Milanese, Milan, Italy.
Francesco
F
Bedgoni
Department of Cardiology, IRCCS Pol San Donato, San Donato Milanese, Milan, Italy.
Luca
L
Testa
Department of Cardiology, Henri Mondor University Hospital, Créteil, France.
Emmanuel
E
Teiger
Heart Center Brandenburg in Bernau, Bernau, Germany.
Christian
C
Butter
Department of Thoracic and Cardiovascular Surgery, Heart and Diabetes Center NRW, Ruhr-University Bochum, Bad Oeynhausen, Germany.
Stephan M
SM
Ensminger
Department of General and Interventional Cardiology, University Heart Center, Hamburg, Germany.
Ulrich
U
Schaefer
Department of Cardiology, St Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada.
Danny
D
Dvir
Department of Cardiology, St Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada.
Philipp
P
Blanke
Department of Cardiology, St Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada.
Jonathon
J
Leipsic
University Heart Center, University Hospital Zurich, Zurich, Switzerland.
Fabian
F
Nietlispach
Heart Center, Segeberger Kliniken GmbH, Academic Teaching Hospital of the Universities of Kiel, Hamburg, and Lübeck, Bad Segeberg, Germany.
Mohamed
M
Abdel-Wahab
Générale de Santé, Institut Cardiovasculaire Paris Sud, Hopital Privé Jacques Cartier, Massy, France.
Bernard
B
Chevalier
Division of Cardiology, Ferrarotto Hospital, University of Catania, Catania, Italy.
Corrado
C
Tamburino
Sussex Cardiac Centre, Brighton and Sussex University Hospitals NHS Trust, Brighton, United Kingdom.
David
D
Hildick-Smith
Division of Cardiovascular Diseases, Intermountain Heart Institute, Salt Lake City, Utah.
Brian K
BK
Whisenant
Division of Cardiology, University of Ulsan, Asan Medical Center, Seoul, Korea.
Seung-Jung
SJ
Park
Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus & San Raffaele Scientific Institute, Milan, Italy San Raffaele Hospital, Milan, Italy.
Antonio
A
Colombo
Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus & San Raffaele Scientific Institute, Milan, Italy San Raffaele Hospital, Milan, Italy.
Azeem
A
Latib
Columbia University Medical Center/New York Presbyterian Hospital, New York, New York.
Susheel K
SK
Kodali
Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands.
Jeroen J
JJ
Bax
The Heart Centre, Rigshospitalet University Hospital, Copenhagen, Denmark.
Lars
L
Søndergaard
Générale de Santé, Institut Cardiovasculaire Paris Sud, Hopital Privé Jacques Cartier, Massy, France.
John G
JG
Webb
Générale de Santé, Institut Cardiovasculaire Paris Sud, Hopital Privé Jacques Cartier, Massy, France.
Thierry
T
Lefèvre
Columbia University Medical Center/New York Presbyterian Hospital, New York, New York.
Martin B
MB
Leon
Department of Interventional Cardiology, Cedars-Sinai Heart Institute, Los Angeles, California.
Raj
R
Makkar
D000368:Aged; D001021:Aortic Valve / Q000002:abnormalities* / Q000601:surgery; D001024:Aortic Valve Stenosis / Q000401:mortality / Q000601:surgery*; D000082882:Bicuspid Aortic Valve Disease; D005260:Female; D014943:Global Health; D006349:Heart Valve Diseases / Q000601:surgery*; D006350:Heart Valve Prosthesis; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D065467:Transcatheter Aortic Valve Replacement / Q000379:methods*; D016896:Treatment Outcome; D014261:Tricuspid Valve / Q000002:abnormalities / Q000601:surgery*
aortic stenosis; bicuspid aortic valve; transcatheter aortic valve implantation