Bicuspid aortic valve type in predicting the occurrence of paravalvular leak following transcatheter aortic valve implantation.

BACKGROUND

Limited information exists on the impact of bicuspid aortic valve (BAV) type on paravalvular leak (PVL) occurrence following transcatheter aortic valve implantation (TAVI).

AIMS: This study aimed to assess whether BAV type and aortic root morphology can predict the development and severity of PVL post-TAVI.

METHODS

We retrospectively analyzed 145 patients with BAV stenosis who underwent TAVI at our center from January 2015 to December 2023. BAVs were classified based on the presence of raphes: 2-sinus BAV, fused BAV (right-left, right-noncoronary, left-noncoronary), and two raphes.

RESULTS

The mean age was 77.4 (7.7) years, with 47.6% being men. Right-left (R-L) cusp fusion was associated with an increased incidence of greater than mild PVL (P = 0.02). Patients with more than mild PVL exhibited higher calcium score (4873 [3554-6514] vs. 3750 [2264-5900]; P = 0.03) and larger dimensions in the ascending aorta (39.8 [4.9] mm vs. 37.9 [5.2] mm; P = 0.045), sinotubular junction (STJ) long axis (33.7 [5.2] mm vs. 31.7 [4.2] mm; P = 0.02), and sinus of Valsalva (34.4 [4.6] mm vs. 32.6 [4.1] mm; P = 0.03) compared to those with ≤ mild PVL. Multivariable analysis showed independent predictors of more than mild PVL as the use of self-expanding prosthesis (P <0.001), STJ dimension (P <0.001), atrial fibrillation prior to TAVI (P = 0.003), and R-L cusp fusion (P = 0.02).

CONCLUSIONS

The incidence of more than mild PVL varied with BAV subtypes and aortic root morphology. Independent factors increasing PVL risk included R-L cusp fusion, self-expanding prosthesis use, extended STJ short axis, and pre-existing atrial fibrillation.