Bicuspid Aortic Valves (VAV) are challenging for TAVR given its anatomical characteristics and the important presence of calcification. However, current data are promising.
Even though traditionally excluded from the larger randomized studies, self-expandable valves appear to have similar evolution to tricuspid aortic valves (TAV) with severe stenosis.
Researchers looked at the Low-Risk Bicuspid Study and the Evolut Low Risk Trial, which were analyzed by the same committee of interventional cardiologists, cardiovascular surgeons and adverse events committee. Inclusion criteria in both studies were identical.
The valves used were Evolut R or Evolut PRO.
Primary end point was the composite of death, disabling stroke and valve related hospitalization at 12 months.
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This study included 150 patients from the Low-Risk Bicuspid Study and 700 from the Evolut Low Risk Trial.
Populations were extremely different, since bicuspid valve patients were younger, more often women, with lower risk factors, atrial fibrillation, and lower STS score vs tricuspid patients. This is why propensity score matching was applied, leaving 145 patients in each group.
Despite variable adjustment, the bicuspid group saw greater need for predilation, the use of valve #34, lower need for valve retrieval, and higher implantation.
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At 30 days events were lower and there were no differences between groups. Neither were there differences between 30 day and one-year outcomes.
At one-year, primary end point was 4.1% for the bicuspid group vs. 6.9% for tricuspids (P=0.304), all-cause mortality was similar (0.7% vs.2.1%), as was disabling stroke (0.7% vs. 0.7%), valve related hospitalization (3.5% vs. 4.9%) and need for pacemaker implantation (17.1% vs. 18.2%).
Gradient was low in both groups, paravalvular lea was higher among tricuspids and there were no differences in moderates.
As regards quality of life and class functional improvement at 30 days and 12 months, there were no differences.
Conclusion
Among patients with bicuspid or tricuspid valve undergoing TAVR with self-expandable valves in a propensity score matched population, there were no significant differences in clinical events or hemodynamic profile at one-year followup.
Dr. Carlos Fava.
Member of the Editorial Board of SOLACI.org
Original Title: Propensity-Matched 1-Year Outcomes Following Transcatheter Aortic Valve Replacement in Low-Risk Bicuspid and Tricuspid Patients.
Reference: G. Michael Deeb, et al. J Am Coll Cardiol Intv 2022;15:511–522.
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