Bicuspid Aortic Valve Morphology and Outcomes After Transcatheter Aortic Valve Replacement

JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY

卷:76

Article

Yoon, Sung-Han¹  Kim, Won-Keun²  Dhoble, Abhijeet³  Pio, Stephan Milhorini⁴  Babaliaros, Vasilis⁵  Jilaihawi, Hasan⁶  Pilgrim, Thomas⁷  De Backer, Ole⁸  Bleiziffer, Sabine⁹  Vincent, Flavien¹⁰  Schmidit, Tobias¹¹  Butter, Christian^12,13  Kamioka, Norihiko⁵  Eschenbach, Lena¹⁴  Renker, Matthias²  Asami, Masahiko⁷  Lazkani, Mohamad¹⁵  Fujita, Buntaro^16,17  Birs, Antoinette¹⁸  Barbanti, Marco¹⁹  Pershad, Ashish²⁰  Landes, Uri^21,22  Oldemeyer, Brad¹⁵  Kitamura, Mitusnobu¹¹  Oakley, Luke¹  Ochiai, Tomoki¹  Chakravarty, Tarun¹  Nakamura, Mamoo¹  Ruile, Philip²³  Deuschl, Florian²⁴  Berman, Daniel¹  Modine, Thomas^10,25  Ensminger, Stephan^16,17  Kornowski, Ran^21,22  Lange, Rudiger¹⁴  McCabe, James M.¹⁸  Williams, Mathew R.⁶  Whisenant, Brian²⁶  Delgado, Victoria⁴  Windecker, Stephan⁷  Van Belle, Eric¹⁰  Sondergaard, Lars⁸  Chevalier, Bernard²⁷  Mack, Michael²⁸  Bax, Jeroen J.⁴  Leon, Martin B.²⁹  Makkar, Raj R.¹ 

[1] Cedars Sinai Med Ctr, Smidt Cedars Sinai Heart Inst, Los Angeles, CA USA

[2] Kerckhoff Heart & Thorax Ctr, Bad Nauheim, Germany

[3] Univ Texas Hlth Sci Ctr, Houston, TX 77030 USA

[4] Leiden Univ, Med Ctr, Leiden, Netherlands

[5] Emory Univ, Sch Med, Atlanta, GA USA

[6] NYU Langone Med Ctr, Dept Cardiol & Cardiothorac Surg, New York, NY USA

[7] Bern Univ Hosp, Bern, Switzerland

[8] Rigshosp, Heart Ctr, Copenhagen, Denmark

[9] Heart & Diabet Ctr North Rhine Westphalia, Bad Oeynhausen, Germany

[10] CHU Lille, Dept Intervent Cardiol Coronary Valves & Struct H, Inst Csur Poumon, Cardiol,Inserm U1011, Lille, France

[11] Asklepios Klin St Georg, Hamburg, Germany

[12] Heart Ctr Brandenburg, Bernau, Germany

[13] Brandenburg Med Sch, Bernau, Germany

[14] German Heart Ctr Munich, Munich, Germany

[15] Univ Colorado Hlth, Loveland, CO USA

[16] Ruhr Univ Bochum, Bad Oeynhausen, Germany

[17] Univ Schleswig Holstein, Dept Cardiac & Thorac Vasc Surg, Lubeck Campus, Lubeck, Germany

[18] Univ Washington, Seattle, WA USA

[19] Univ Catania, Catania, Italy

[20] Banner Univ Med Ctr, Phoenix, AZ USA

[21] Rabin Med Ctr, Cardiol Dept, Petah Tiqwa, Israel

[22] Tel Aviv Univ, Tel Aviv, Israel

[23] Univ Heart Ctr Freiburg Bad Krozingen, Dept Cardiol Angiol 2, Bad Krozingen, Germany

[24] Univ Heart Ctr, Struct Heart Div, Hamburg, Germany

[25] Bordeaux Univ Hosp, Bordeaux, France

[26] Intermt Heart Inst, Salt Lake City, UT USA

[27] Ramsay Gen Sante Inst Cardiovasc Paris Sud, Massy, France

[28] Baylor Scott & White Hlth Heart Hosp Plano, Plano, TX USA

[29] Columbia Univ, Med Ctr, New York Presbyterian Hosp, New York, NY USA

关键词: aortic stenosis;    bicuspid aortic valve;    transcatheter aortic valve implantation;   

DOI  :  10.1016/j.jacc.2020.07.005

来源: Elsevier

【 摘 要 】

BACKGROUND Bicuspid aortic stenosis accounts for almost 50% of patients undergoing surgical aortic valve replacement in the younger patients. Expanding the indication of transcatheter aortic valve replacement (TAVR) toward lower-risk and younger populations will lead to increased use of TAVR for patients with bicuspid aortic valve (BAV) stenosis despite the exclusion of bicuspid anatomy in all pivotal clinical trials. OBJECTIVES This study sought to evaluate the association of BAV morphology and outcomes of TAVR with the new-generation devices. METHODS Patients with BAV confirmed by central core laboratory computed tomography (CT) analysis were included from the international multicenter BAV TAVR registry. BAV morphology including the number of raphe, calcification grade in raphe, and leaflet calcium volume were assessed with CT analysis in a masked fashion. Primary outcomes were all-cause mortality at 1 and 2 years, and secondary outcomes included 30-day major endpoints and procedural complications. RESULTS A total of 1,034 CT-confirmed BAV patients with a mean age of 74.7 years and Society of Thoracic Surgeons score of 3.7% underwent TAVR with contemporary devices (n = 740 with Sapien 3; n = 188 with Evolut R/Pro; n = 106 with others). All-cause 30-day, 1-year, and 2-year mortality was 2.0%, 6.7%, and 12.5%, respectively. Multivariable analysis identified calcified raphe and excess leaflet calcification (defined as more than median calcium volume) as independent predictors of 2-year all-cause mortality. Both calcified raphe plus excess leaflet calcification were found in 269 patients (26.0%), and they had significantly higher 2-year all-cause mortality than those with 1 or none of these morphological features (25.7% vs. 9.5% vs. 5.9%; log-rank p < 0.001). Patients with both morpho-logical features had higher rates of aortic root injury (p < 0.001), moderate-to-severe paravalvular regurgitation (p = 0.002), and 30-day mortality (p = 0.016). CONCLUSIONS Outcomes of TAVR in bicuspid aortic stenosis depend on valve morphology. Calcified raphe and excess leaflet calcification were associated with increased risk of procedural complications and midterm mortality. (c) 2020 by the American College of Cardiology Foundation.

【 授权许可】

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