Outcomes in Transcatheter Aortic Valve Replacement for Bicuspid Versus Tricuspid Aortic Valve Stenosis.
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Yoon Sung-Han, Bleiziffer Sabine, De Backer Ole, Delgado Victoria, Arai Takahide, Ziegelmueller Johannes, Barbanti Marco, Sharma Rahul, Perlman Gidon Y, Khalique Omar K, Holy Erik W, Saraf Smriti, Deuschl Florian, Fujita Buntaro, Ruile Philipp, Neumann Franz-Josef, Pache Gregor, Takahashi Masao, Kaneko Hidehiro, Schmidt Tobias, Ohno Yohei, Schofer Niklas, Kong William K F, Tay Edgar, Sugiyama Daisuke, Kawamori Hiroyuki, Maeno Yoshio, Abramowitz Yigal, Chakravarty Tarun, Nakamura Mamoo, Kuwata Shingo, Yong Gerald, Kao Hsien-Li, Lee Michael, Kim Hyo-Soo, Modine Thomas, Wong S Chiu, Bedgoni Francesco, Testa Luca, Teiger Emmanuel, Butter Christian, Ensminger Stephan M, Schaefer Ulrich, Dvir Danny, Blanke Philipp, Leipsic Jonathon, Nietlispach Fabian, Abdel-Wahab Mohamed, Chevalier Bernard, Tamburino Corrado, Hildick-Smith David, Whisenant Brian K, Park Seung-Jung, Colombo Antonio, Latib Azeem, Kodali Susheel K, Bax Jeroen J, Søndergaard Lars, Webb John G, Lefèvre Thierry, Leon Martin B, Makkar Raj
Аннотация
OBJECTIVES: 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.