Transcatheter aortic valve implantation in bicuspid anatomy: Procedural results with two different types of valves

Research output: Contribution to journalArticle

Abstract

BACKGROUND: It is well known that bicuspid valve stenosis can be treated with transcatheter aortic valve implantation (TAVI) even if specific issues can cause problems: dilatation of ascending aorta, possible aorthopathy, eccentricity of the valve and calcium distribution in leaflets and in commissures. We classified Bicuspid aortic valve (BAV) in type 0 (2 cusps and no raphe), and type 1 (2 cusps and one or more raphes). The aim of the present study was to report the results of two types of valve (CoreValve from 2009 to 2016 and Lotus valve from 2014 to 2017) in a consecutive series of BAV patients treated in 2 Italian centers. METHODS? A total of 30 patients with BAV underwent TAVI from September 2009 to March 2017. RESULTS? Mean age was 78±8 years, 54.5% were males and 7.4% had peripheral vasculopathy, 6.5% previous stroke or TIA, 15.6% previous PCI and 9.4% previous coronary artery bypass grafting. Ten patients (30.3%) had a type 1; mean aortic valvular gradient was 57.7±17.7 mmHg; aortic valvular area was 0.7±0.2 mm2, left ventricular ejection fraction was 51.4±10.0% and ascending aorta was 41.0±5.6 mm. Among these 30 patients, 16 of them (group 1) undergone CoreValve implantation and 14 (group 2) undergone Lotus valve implantation. Patients in the first group had a higher Logistic Euroscore (P<0.001) and higher AVA (P=0.026) and valve area CT (P=0.003). Device size in group1 was more often bigger than in group 2 (P<0.001) and postdilatation was never used in the last group. Group 1 had a significant more frequent aortic regurgitation ≥2 assessed with angiography (28.6% vs. 0%; P=0.05). A non-statistically significant higher rate of second valve implantation (6.2% vs. 0%; P=1.00) was also observed. New permanent pacemaker implantation (40.0% vs. 35.7%; P=0.812) was equal in both valves. CONCLUSIONS? Postprocedural aortic regurgitation is still an issue in BAV undergone TAVI when: 1) the annulus is big; 2) when we are using self-expandable valves; and 3) in type 0 valves. Lotus valve, with a higher radial force put in a small annuls seems associated to better procedural outcomes in this subset of patients.

Original languageEnglish
Pages (from-to)129-135
Number of pages7
JournalMinerva Cardioangiologica
Volume66
Issue number2
DOIs
Publication statusPublished - Apr 1 2018

Fingerprint

Bicuspid
Anatomy
Aortic Valve Insufficiency
Aorta
Mitral Valve
Coronary Artery Bypass
Stroke Volume
Transcatheter Aortic Valve Replacement
Dilatation
Angiography
Pathologic Constriction
Stroke
Calcium
Equipment and Supplies
Bicuspid Aortic Valve

Keywords

  • Aortic valve stenosis
  • Bicuspid aortic valve
  • Transcatheter aortic valve implantation

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

@article{06691cc83fb842c5aa897f94d156602e,
title = "Transcatheter aortic valve implantation in bicuspid anatomy: Procedural results with two different types of valves",
abstract = "BACKGROUND: It is well known that bicuspid valve stenosis can be treated with transcatheter aortic valve implantation (TAVI) even if specific issues can cause problems: dilatation of ascending aorta, possible aorthopathy, eccentricity of the valve and calcium distribution in leaflets and in commissures. We classified Bicuspid aortic valve (BAV) in type 0 (2 cusps and no raphe), and type 1 (2 cusps and one or more raphes). The aim of the present study was to report the results of two types of valve (CoreValve from 2009 to 2016 and Lotus valve from 2014 to 2017) in a consecutive series of BAV patients treated in 2 Italian centers. METHODS? A total of 30 patients with BAV underwent TAVI from September 2009 to March 2017. RESULTS? Mean age was 78±8 years, 54.5{\%} were males and 7.4{\%} had peripheral vasculopathy, 6.5{\%} previous stroke or TIA, 15.6{\%} previous PCI and 9.4{\%} previous coronary artery bypass grafting. Ten patients (30.3{\%}) had a type 1; mean aortic valvular gradient was 57.7±17.7 mmHg; aortic valvular area was 0.7±0.2 mm2, left ventricular ejection fraction was 51.4±10.0{\%} and ascending aorta was 41.0±5.6 mm. Among these 30 patients, 16 of them (group 1) undergone CoreValve implantation and 14 (group 2) undergone Lotus valve implantation. Patients in the first group had a higher Logistic Euroscore (P<0.001) and higher AVA (P=0.026) and valve area CT (P=0.003). Device size in group1 was more often bigger than in group 2 (P<0.001) and postdilatation was never used in the last group. Group 1 had a significant more frequent aortic regurgitation ≥2 assessed with angiography (28.6{\%} vs. 0{\%}; P=0.05). A non-statistically significant higher rate of second valve implantation (6.2{\%} vs. 0{\%}; P=1.00) was also observed. New permanent pacemaker implantation (40.0{\%} vs. 35.7{\%}; P=0.812) was equal in both valves. CONCLUSIONS? Postprocedural aortic regurgitation is still an issue in BAV undergone TAVI when: 1) the annulus is big; 2) when we are using self-expandable valves; and 3) in type 0 valves. Lotus valve, with a higher radial force put in a small annuls seems associated to better procedural outcomes in this subset of patients.",
keywords = "Aortic valve stenosis, Bicuspid aortic valve, Transcatheter aortic valve implantation",
author = "Patrizia Presbitero and Loredana Iannetta and Paolo Pagnotta and Bernhard Reimers and Rossi, {Marco L.} and {Zavalloni Parenti}, Dennis and Giovanni Bianchi and Francesco Bedogni",
year = "2018",
month = "4",
day = "1",
doi = "10.23736/S0026-4725.17.04531-5",
language = "English",
volume = "66",
pages = "129--135",
journal = "Minerva Cardioangiologica",
issn = "0026-4725",
publisher = "Edizioni Minerva Medica S.p.A.",
number = "2",

}

TY - JOUR

T1 - Transcatheter aortic valve implantation in bicuspid anatomy

T2 - Procedural results with two different types of valves

AU - Presbitero, Patrizia

AU - Iannetta, Loredana

AU - Pagnotta, Paolo

AU - Reimers, Bernhard

AU - Rossi, Marco L.

AU - Zavalloni Parenti, Dennis

AU - Bianchi, Giovanni

AU - Bedogni, Francesco

PY - 2018/4/1

Y1 - 2018/4/1

N2 - BACKGROUND: It is well known that bicuspid valve stenosis can be treated with transcatheter aortic valve implantation (TAVI) even if specific issues can cause problems: dilatation of ascending aorta, possible aorthopathy, eccentricity of the valve and calcium distribution in leaflets and in commissures. We classified Bicuspid aortic valve (BAV) in type 0 (2 cusps and no raphe), and type 1 (2 cusps and one or more raphes). The aim of the present study was to report the results of two types of valve (CoreValve from 2009 to 2016 and Lotus valve from 2014 to 2017) in a consecutive series of BAV patients treated in 2 Italian centers. METHODS? A total of 30 patients with BAV underwent TAVI from September 2009 to March 2017. RESULTS? Mean age was 78±8 years, 54.5% were males and 7.4% had peripheral vasculopathy, 6.5% previous stroke or TIA, 15.6% previous PCI and 9.4% previous coronary artery bypass grafting. Ten patients (30.3%) had a type 1; mean aortic valvular gradient was 57.7±17.7 mmHg; aortic valvular area was 0.7±0.2 mm2, left ventricular ejection fraction was 51.4±10.0% and ascending aorta was 41.0±5.6 mm. Among these 30 patients, 16 of them (group 1) undergone CoreValve implantation and 14 (group 2) undergone Lotus valve implantation. Patients in the first group had a higher Logistic Euroscore (P<0.001) and higher AVA (P=0.026) and valve area CT (P=0.003). Device size in group1 was more often bigger than in group 2 (P<0.001) and postdilatation was never used in the last group. Group 1 had a significant more frequent aortic regurgitation ≥2 assessed with angiography (28.6% vs. 0%; P=0.05). A non-statistically significant higher rate of second valve implantation (6.2% vs. 0%; P=1.00) was also observed. New permanent pacemaker implantation (40.0% vs. 35.7%; P=0.812) was equal in both valves. CONCLUSIONS? Postprocedural aortic regurgitation is still an issue in BAV undergone TAVI when: 1) the annulus is big; 2) when we are using self-expandable valves; and 3) in type 0 valves. Lotus valve, with a higher radial force put in a small annuls seems associated to better procedural outcomes in this subset of patients.

AB - BACKGROUND: It is well known that bicuspid valve stenosis can be treated with transcatheter aortic valve implantation (TAVI) even if specific issues can cause problems: dilatation of ascending aorta, possible aorthopathy, eccentricity of the valve and calcium distribution in leaflets and in commissures. We classified Bicuspid aortic valve (BAV) in type 0 (2 cusps and no raphe), and type 1 (2 cusps and one or more raphes). The aim of the present study was to report the results of two types of valve (CoreValve from 2009 to 2016 and Lotus valve from 2014 to 2017) in a consecutive series of BAV patients treated in 2 Italian centers. METHODS? A total of 30 patients with BAV underwent TAVI from September 2009 to March 2017. RESULTS? Mean age was 78±8 years, 54.5% were males and 7.4% had peripheral vasculopathy, 6.5% previous stroke or TIA, 15.6% previous PCI and 9.4% previous coronary artery bypass grafting. Ten patients (30.3%) had a type 1; mean aortic valvular gradient was 57.7±17.7 mmHg; aortic valvular area was 0.7±0.2 mm2, left ventricular ejection fraction was 51.4±10.0% and ascending aorta was 41.0±5.6 mm. Among these 30 patients, 16 of them (group 1) undergone CoreValve implantation and 14 (group 2) undergone Lotus valve implantation. Patients in the first group had a higher Logistic Euroscore (P<0.001) and higher AVA (P=0.026) and valve area CT (P=0.003). Device size in group1 was more often bigger than in group 2 (P<0.001) and postdilatation was never used in the last group. Group 1 had a significant more frequent aortic regurgitation ≥2 assessed with angiography (28.6% vs. 0%; P=0.05). A non-statistically significant higher rate of second valve implantation (6.2% vs. 0%; P=1.00) was also observed. New permanent pacemaker implantation (40.0% vs. 35.7%; P=0.812) was equal in both valves. CONCLUSIONS? Postprocedural aortic regurgitation is still an issue in BAV undergone TAVI when: 1) the annulus is big; 2) when we are using self-expandable valves; and 3) in type 0 valves. Lotus valve, with a higher radial force put in a small annuls seems associated to better procedural outcomes in this subset of patients.

KW - Aortic valve stenosis

KW - Bicuspid aortic valve

KW - Transcatheter aortic valve implantation

UR - http://www.scopus.com/inward/record.url?scp=85044522382&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85044522382&partnerID=8YFLogxK

U2 - 10.23736/S0026-4725.17.04531-5

DO - 10.23736/S0026-4725.17.04531-5

M3 - Article

C2 - 29512361

AN - SCOPUS:85044522382

VL - 66

SP - 129

EP - 135

JO - Minerva Cardioangiologica

JF - Minerva Cardioangiologica

SN - 0026-4725

IS - 2

ER -