A Bicuspid Aortic Valve Imaging Classification for the TAVR Era.
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Jilaihawi Hasan, Chen Mao, Webb John, Himbert Dominique, Ruiz Carlos E, Rodés-Cabau Josep, Pache Gregor, Colombo Antonio, Nickenig Georg, Lee Michael, Tamburino Corrado, Sievert Horst, Abramowitz Yigal, Tarantini Giuseppe, Alqoofi Faisal, Chakravarty Tarun, Kashif Mohammad, Takahashi Nobuyuki, Kazuno Yoshio, Maeno Yoshio, Kawamori Hiroyuki, Chieffo Alaide, Blanke Philipp, Dvir Danny, Ribeiro Henrique Barbosa, Feng Yuan, Zhao Zhen-Gang, Sinning Jan-Malte, Kliger Chad, Giustino Gennaro, Pajerski Basia, Imme Sebastiano, Grube Eberhard, Leipsic Jonathon, Vahanian Alec, Michev Iassen, Jelnin Vladimir, Latib Azeem, Cheng Wen, Makkar Raj
Аннотация
BACKGROUND: TAVR has been used to treat BAV-AS but with heterogeneous outcomes and uncertainty regarding the relevance of morphology.
METHODS: 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.
RESULTS: 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).
CONCLUSIONS: 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.