Original Title: Bicuspid Aortic Valve Stenosis Favorable Early Outcomes UIT a Next-Generation Transcatheter Heart Valve in a Multicenter Study. Reference: Gidon Y. Perlman J Am Coll Cardiol Interv 2016;9:817-24
Courtesy of Dr. Carlos Fava.
Congenital bicuspid aortic valves are infrequent and are associated with severe calcification in elderly patients.
Transcatheter aortic valve replacement to treat bicuspid aortic stenosis is challenging because of their anatomical characteristics and there is not enough evidence on its outcomes.
This study included 51 patients with bicuspid aortic valves receiving an Edwards SAPIENS 3.
Mean patient age was 76 and little more than half were women with STS score 5.2±3.7%.
The procedure was done in 20 patients under sedation and local anesthetics, two via carotid access and the rest via femoral.
There were no deaths, malposition, embolization, second valves or conversion to surgery.
At 30 days, the gradient decreased from 49.4±16 mmHg at baseline to 11.2±4.7 mmHg, and the area increased from 0.7±0.2 cm2 to 1.7±0.3 cm2. There was none/trivial aortic regurgitation in 32 patients and none presented moderate or severe regurgitation.
During the first month, there were 2 deaths, 2 major vascular complications and 12 patients required a definite pacemaker.
The need for a definite pacemaker was associated with implantation >8 mm below annulus level (low implantation, 55% need for pacemaker vs. 10% higher implantation; p=0.01).
Conclusion
TAVI in bicuspid valves with new generation devices was feasible and effective with a favorable performance and no cases of moderate or severe aortic regurgitation.
Editorial Comment
Bicuspid valves are different in morphology, are more calcified and are associated with moderate and severe aortic regurgitation.
New generation valves improve performance and encourage us to advance with this group, improving accuracy of position implantation position in order to avoid pacemaker implantation after TAVI.
Courtesy of Dr. Carlos Fava.
Interventional Cardiologist
Favaloro Foundation – Buenos Aires