Association of bicuspid aortic valve stenosis with higher risk for hypoattenuated leaflet thickening following transcatheter aortic valve replacement.

BACKGROUND

The association between hypoattenuated leaflet thickening (HALT) after transcatheter aortic valve replacement (TAVR) and the risk of cerebrovascular events has attracted much attention. Although previous studies have reported that the incidence of HALT after TAVR in patients with bicuspid aortic valve (BAV) is comparable to that in patients with tricuspid aortic valve (TAV), the specific contributing factors remain incompletely understood. This study aimed to investigate the incidence, predictors, and prognosis of HALT in a TAVR cohort of young patients with 50-50% bicuspid-TAV anatomy.

METHODS

We retrospectively analyzed consecutive patients with severe symptomatic aortic stenosis who underwent the TAVR procedure between May 2012 and January 2021 in West China Hospital, Sichuan University. Multislice computed tomography (MSCT) was employed to evaluate the early HALT post-TAVR at discharge. Echocardiograms were conducted at baseline, upon discharge, 30 days after the procedure, and at 1-year follow-up. Patients were grouped according to the presence of HALT at discharge. The baseline data, procedural details, and clinical outcomes of the patients were compared, and then multivariate regression analysis was performed.

RESULTS

We ultimately enrolled 605 patients undergoing TAVR for severe symptomatic aortic stenosis, of whom 79 (13.1%) developed HALT during hospitalization. The incidence of HALT was significantly higher in patients with BAV than in those with TAV (15.9% vs. 10.2%; P=0.04). In the multivariate analysis, BAV was identified as an independent predictor of HALT [odds ratio (OR) =2.148; 95% confidence interval (CI): 1.283-3.596; P=0.004]. The other independent predictors included coronary artery disease (OR =1.810; 95% CI: 1.091-2.768; P=0.02), higher body mass index (OR =0.912; 95% CI: 0.846-0.982; P=0.02), postdilation (OR =0.552; 95% CI: 0.327-0.934; P=0.03), bioprosthetic valve size >23 mm (OR =1.965; 95% CI: 1.013-3.813; P=0.05), and the presence of a greater-than-mild paravalvular leak (OR =0.28; 95% CI: 0.13-0.62; P=0.001). In terms of clinical outcomes, there were no significant differences in stroke or death between the HALT group or the non-HALT group at 30 days or 1 year.

CONCLUSIONS

BAV was associated with higher risk of early HALT after TAVR, whereas the presence of HALT was not associated with stroke or death at 1 year. The underlying mechanisms and long-term prognosis of HALT after TAVR in patients with BAV remain to be further investigated.