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Transcatheter Aortic Valve Replacement

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Transcatheter Aortic Valve Implantation Represents an Anti-Inflammatory Therapy Via Reduction of Shear Stress-Induced, Piezo-1-Mediated Monocyte Activation Third-Generation Balloon and Self-Expandable Valves for Aortic Stenosis in Large and Extra-Large Aortic Annuli From the TAVR-LARGE Registry Bioprosthetic valve oversizing is associated with increased risk of valve thrombosis following TAVR 2020 ACC Expert Consensus Decision Pathway on Management of Conduction Disturbances in Patients Undergoing Transcatheter Aortic Valve Replacement A Report of the American College of Cardiology Solution Set Oversight Committee Decline in Left Ventricular Ejection Fraction During Follow-Up in Patients With Severe Aortic Stenosis Comparison of newer generation self-expandable vs. balloon-expandable valves in transcatheter aortic valve implantation: the randomized SOLVE-TAVI trial Association of Smoking Status With Long‐Term Mortality and Health Status After Transcatheter Aortic Valve Replacement: Insights From the Society of Thoracic Surgeons/American College of Cardiology Transcatheter Valve Therapy Registry Cardiac surgery following transcatheter aortic valve replacement Computed tomography angiography-derived extracellular volume fraction predicts early recovery of left ventricular systolic function after transcatheter aortic valve replacement Health Status After Transcatheter Versus Surgical Aortic Valve Replacement in Low-Risk Patients With Aortic Stenosis
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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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