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Transcatheter Aortic Valve Replacement

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A prospective, randomised trial of transapical transcatheter aortic valve implantation vs. surgical aortic valve replacement in operable elderly patients with aortic stenosis: the STACCATO trial Risk of Coronary Obstruction and Feasibility of Coronary Access After Repeat Transcatheter Aortic Valve Replacement With the Self-Expanding Evolut Valve: A Computed Tomography Simulation Study Comparison of Safety and Periprocedural Complications of Transfemoral Aortic Valve Replacement Under Local Anaesthesia: Minimalist Versus Complete Heart Team Left Ventricular Rapid Pacing Via the Valve Delivery Guidewire in Transcatheter Aortic Valve Implantation Relationship Between Hospital Surgical Aortic Valve Replacement Volume and Transcatheter Aortic Valve Replacement Outcomes Short Length of Stay After Elective Transfemoral Transcatheter Aortic Valve Replacement Is Not Associated With Increased Early or Late Readmission Risk Timing of intervention in asymptomatic patients with valvular heart disease Transcatheter and surgical aortic valve replacement in patients with bicuspid aortic valve Early Versus Standard Discharge After Transcatheter Aortic Valve Replacement: A Systematic Review and Meta-Analysis Meta-Analysis of Effectiveness and Safety of Transcatheter Aortic Valve Implantation Versus Surgical Aortic Valve Replacement in Low-to-Intermediate Surgical Risk Cohort
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Original Research2021 Jan 3.

JOURNAL：Clin Res Cardiol. Article Link

Predictors of high residual gradient after transcatheter aortic valve replacement in bicuspid aortic valve stenosis

G Bugani, M Pagnesi, D Tchetchè et al. Keywords: TAVR; balloon-expandable valve; bicuspid; high residual gradient; self-expandable valve;

ABSTRACT

OBJECTIVES - To define the incidence of high residual gradient (HRG) after transcatheter aortic valve replacement (TAVR) in BAVs and their impact on short term outcome and 1-year mortality.


BACKGROUND - Transcatheter heart valves (THVs) offer good performance in tricuspid aortic valves with low rate of HRG. However, data regarding their performance in bicuspid aortic valves (BAV) are still lacking.


METHODS - The BEAT (Balloon vs Self-Expandable valve for the treatment of bicuspid Aortic valve sTenosis) registry included 353 consecutive patients who underwent TAVR (Evolut R/PRO or Sapien 3 valves) in BAV between June 2013 and October 2018. The primary endpoint was device unsuccess with post-procedural HRG (mean gradient ≥ 20 mmHg). The secondary endpoint was to identify the predictors of HRG following the procedure.


RESULTS - Twenty patients (5.6%) showed HRG after TAVR. Patients with HRG presented higher body mass index (BMI) (30.7 ± 9.3 vs. 25.9 ± 4.8; p < 0.0001) and higher baseline aortic mean gradients (57.6 ± 13.4 mmHg vs. 47.7 ± 16.6, p = 0.013) and more often presented with BAV of Sievers type 0 than patients without HRG. At multivariate analysis, BMI [odds ratio (OR) 1.12; 95% confidence interval (CI) 1.05–1.20, p = 0.001] and BAV type 0 (OR 11.31, 95% CI 3.45–37.06, p < 0.0001) were confirmed as independent predictors of high gradient.


CONCLUSION - HRG following TAVR in BAVs is not negligible and is higher among patients with high BMI and with BAV 0 anatomy.


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