Long-Term Durability of Transcatheter Aortic Valves in Patients With Bicuspid Aortic Stenosis.
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Jia Yuheng, Maznyczka Annette, Boiago Mauro, Khokhar Arif, Tomii Daijiro, Neylon Antoinette, Danthine Pauline, Levesque Thomas, Bamford Paul, Toggweiler Stefan, Moccetti Federico, Piuhola Jarkko, Adamo Marianna, Massussi Mauro, Ielasi Alfonso, Montorfano Matteo, Costa Giulia, Swaans Martin, Overduin Daniël C, Servoz Clément, Gandolfo Caterina, Guðmundsdóttir Ingibjörg Jóna, Salizzoni Stefano, Wykrzykowska Joanna J, van Bergeijk Kees H, Buono Andrea, Hartikainen Tau, Noble Stephane, Mylotte Darren, Brecker Stephen, Thabit Ahmed, Mangieri Antonio, Agostoni Pierfrancesco, Bunc Matjaž, Vanhaverbeke Maarten, Bosmans Johan, Eltchaninoff Hélène, Latib Azeem, Blackman Daniel, Van Mieghem Nicolas M, Feng Yuan, Kim Won-Keun, Pilgrim Thomas, Prendergast Bernard, Tchétché Didier, Chen Mao, De Backer Ole
Аннотация
AIMS: The study aims to report data on long-term valve durability following transcatheter aortic valve replacement (TAVR) in bicuspid AS.
METHODS: This multicentre registry included patients who underwent TAVR for bicuspid AS with at least 2-year echocardiographic follow-up. The incidence of structural valve deterioration (SVD), bioprosthetic valve dysfunction (BVD), and bioprosthetic valve failure (BVF) was determined according to Valve Academic Research Consortium (VARC)-3 criteria.
RESULTS: Among 894 patients (mean age: 75.6 years; 39% female), the median echocardiographic follow-up was 48.7 months with a 5-year cumulative incidence of moderate-to-severe SVD, severe SVD, severe BVD, and BVF of 8.1%, 3.2%, 11.4%, and 6.1%, respectively. Younger age (≤ 75 years) was associated with a higher likelihood of reintervention (HR 2.40, log-rank p = 0.04). TAV downsizing was associated with higher rates of moderate-to-severe SVD (HR 3.05, log-rank p < 0.001), severe BVD (HR 2.07, log-rank p = 0.003), and BVF (HR 3.25, log-rank p = 0.002). In the sub-group with small annuli (area ≤ 430 mm2), implantation of balloon-expandable TAVs was associated with a higher rate of BVD in comparison with self-expanding TAVs (HR: 3.27, log-rank p = 0.008).
CONCLUSIONS: TAVs demonstrated favorable 5-year durability in patients with bicuspid AS, although younger patients were more likely to require valve reintervention. Nominal TAV sizing was associated with better durability outcomes as compared to TAV downsizing. Self-expanding valves were associated with superior hemodynamics in patients with small annuli.