Original title: Transcatheter Aortic Valve Replacement in Bicuspid Aortic Valve Disease. Reference: Darren Mylotte, et al. J Am Coll Cardiol 2014;64:2330-9

The bicuspid aortic valve (BAV) is present between 0.5% and 2% of the general population and up to 20% of patients older than 80 years who require aortic valve surgery. Literature on     transcatheter aortic valve replacement (TAVR-TAVI) in this pathology is limited. This study included 139 patients with severe aortic stenosis, aortic regurgitation or both by BAV who received TAVR. The endpoint at 30 days was the safety and efficacy of the method according to the VARC criteria. The valves used were; CoreValve in 91 patients and Sapiens in 48. The femoral access was the most frequent and the implant was successful in 98.6% of patients. 

The diameter of the implanted valve was 27.8 ± 2 mm, requiring post dilatation in 25 patients and a second valve in five. A 30-day mortality was 5%, myocardial 2.2%, stroke 2.2%, bleeding with threatened life 7.2% and higher vascular complication 6.5%. Mortality of any at 6 and 12 months was 9.6% and 17.5% respectively. At 12 months, 90% of patients were in functional class I-II. In the multivariate analysis, vascular complication was associated with higher mortality (OR: 5.66, CI 95%, 1.21 to 26.43; p = 0.03). The presence of aortic regurgitation ≥2 to 30 days was observed in 28.4% of the population. In patients who valve was chose based on multislice CT measurements, less aortic regurgitation was observed ≥2.

Conclusion

TAVR in bicuspid aortic valve is feasible with promising results in the short and medium term. Has a higher incidence of aortic regurgitation that could improve with a more accurate measurement of the ring, using tomography. More studies are needed to evaluate at long-term.

Comment

BAV has a different anatomy with more asymmetric calcification and aortic arch disruption hindering the correct implantation of the valve. All these points make today the treatment by TAVR of those patients to be an off-label indication. With current valves this study showed satisfactory results, especially when the anatomy is evaluated using multislice CT. It is necessary to develop valves for this disease and further studies with longer follow. 

Courtesy of Carlos Fava, MD
Interventional cardiologist
Favaloro Foundation
Buenos Aires – Argentina

Carlos Fava