Vol 24, No 4 (2017)
Original articles — Interventional cardiology
Published online: 2017-02-15

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Hemodynamic changes after transcatheter aortic valve implantation during sequential follow-ups in patients with bicuspid aortic valve compared with tricuspid aortic valve

Tian-Yuan Xiong, Ming-Xia Zheng, Xin Wei, Yi-Jian Li, Yan-Biao Liao, Zhen-Gang Zhao, Yuan-Ning Xu, Hong Tang, Yuan Feng, Mao Chen
Pubmed: 28248407
Cardiol J 2017;24(4):350-357.


Background: To investigate the individual sequential hemodynamic changes after transcatheter aortic valve implantation (TAVI), especially for patients with bicuspid aortic valve (BAV), in comparison with tricuspid aortic valve (TAV).

Methods: The study population comprised 85 patients with severe aortic stenosis who underwent TAVI for BAV (n = 49) or TAV (n = 36) with at least two serial echocardiographic follow-ups. Doppler echocardiography was scheduled to be performed at discharge and 1, 3, 6 months and 1 year after the procedure. D peak transvalvular velocities and D mean transvalvular gradients were calculated as the difference at follow-up time points and discharge. Paravalvular leak (PVL) was assessed as another indicator for prosthesis performance.

Results: Comparisons between patients with BAV and TAV revealed similar gradient performances (1.00 [–2.00, 2.00] vs. 1.00 [–0.25, 5.00] mm Hg, p = 0.57 at 1 month; –0.71 ± 7.52 vs. 1.55 ± 3.97 mm Hg, p = 0.21 at 3 months; 0.96 ± 7.81 vs. 1.53 ± 5.85 mm Hg, p = 0.79 at 6 months; 1.00 [–0.50, 2.25] vs. 3.00 [–0.50, 7.50] mm Hg, p = 0.07 at 1 year). Moreover, the incidence of ≥ mild PVL was not significantly different in patients with BAV and TAV during follow-up (34.88% vs. 19.35%, p = 0.14 at 1 month; 45.83% vs. 27.27%, p = 0.19 at 3 months; 30.00% vs. 23.53%, p = 0.89 at 6 months; 30.00% vs. 17.65%, p = 0.56 at 1 year).

Conclusions: TAVI is effective and applicable in BAV anatomy with sustained and acceptable mid- -term prosthesis hemodynamic performance. (Cardiol J 2017; 24, 4: 350–357)

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  1. Douglas PS, Hahn RT, Pibarot P, et al. Hemodynamic outcomes of transcatheter aortic valve replacement and medical management in severe, inoperable aortic stenosis: a longitudinal echocardiographic study of cohort B of the PARTNER trial. J Am Soc Echocardiogr. 2015; 28(2): 210–217.e1.
  2. Gotzmann M, Lindstaedt M, Bojara W, et al. Hemodynamic results and changes in myocardial function after transcatheter aortic valve implantation. Am Heart J. 2010; 159(5): 926–932.
  3. Oh JK, Little SH, Abdelmoneim SS, et al. CoreValve U.S. Pivotal Trial Clinical Investigators. Regression of Paravalvular Aortic Regurgitation and Remodeling of Self-Expanding Transcatheter Aortic Valve: An Observation From the CoreValve U.S. Pivotal Trial. JACC Cardiovasc Imaging. 2015; 8(12): 1364–1375.
  4. Gulino S, Barbanti M, Deste W, et al. Four-year durability of clinical and haemodynamic outcomes of transcatheter aortic valve implantation with the self-expanding CoreValve. EuroIntervention. 2016; 12(8): e1031–e1038.
  5. Barbanti M, Petronio AS, Ettori F, et al. 5-Year Outcomes After Transcatheter Aortic Valve Implantation With CoreValve Prosthesis. JACC Cardiovasc Interv. 2015; 8(8): 1084–1091.
  6. Spethmann S, Dreger H, Baldenhofer G, et al. Long-term Doppler hemodynamics and effective orifice areas of Edwards SAPIEN and medtronic CoreValve prostheses after TAVI. Echocardiography. 2014; 31(3): 302–310.
  7. Zegdi R, Ciobotaru V, Noghin M, et al. Is it reasonable to treat all calcified stenotic aortic valves with a valved stent? Results from a human anatomic study in adults. J Am Coll Cardiol. 2008; 51(5): 579–584.
  8. Mylotte D, Lefevre T, Søndergaard L, et al. Transcatheter aortic valve replacement in bicuspid aortic valve disease. J Am Coll Cardiol. 2014; 64(22): 2330–2339.
  9. Nishimura RA, Otto C, Bonow R, et al. 2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease. Journal of the American College of Cardiology. 2014; 63(22): e57–e185.
  10. Cerillo AG, Mariani M, Berti S, et al. Sizing the aortic annulus. Ann Cardiothorac Surg. 2012; 1(2): 245–256.
  11. Jilaihawi H, Wu Y, Yang Y, et al. Morphological characteristics of severe aortic stenosis in China: imaging corelab observations from the first Chinese transcatheter aortic valve trial. Catheter Cardiovasc Interv. 2015; 85 Suppl 1: 752–761.
  12. Grube E, Laborde JC, Gerckens U, et al. Percutaneous implantation of the CoreValve self-expanding valve prosthesis in high-risk patients with aortic valve disease: the Siegburg first-in-man study. Circulation. 2006; 114(15): 1616–1624.
  13. Testa L, Brambilla N, Laudisa ML, et al. Safety and efficacy of the subclavian approach for transcatheter aortic valve implantation with the CoreValve revalving system. Circ Cardiovasc Interv. 2010; 3(4): 359–366.
  14. Zamorano JL, Badano LP, Bruce C, et al. EAE/ASE recommendations for the use of echocardiography in new transcatheter interventions for valvular heart disease. J Am Soc Echocardiogr. 2011; 24(9): 937–965.
  15. Kappetein AP, Head SJ, Généreux P, et al. Updated standardized endpoint definitions for transcatheter aortic valve implantation: the Valve Academic Research Consortium-2 consensus document. Eur Heart J. 2012; 33(19): 2403–2418.
  16. Jilaihawi H, Chen M, Webb J, et al. A Bicuspid Aortic Valve Imaging Classification for the TAVR Era. JACC Cardiovasc Imaging. 2016; 9(10): 1145–1158.
  17. Cardiovascular Internal Medicine Branch of Chinese Medical Association Professional Committee of Structural Cardiology. Transcatheter aortic valve replacement: consensus from Chinese experts (Chinese). Chin. J. Interv. Cardiol. 2015; 23(12):661–667.
  18. Hayashida K, Bouvier E, Lefèvre T, et al. Transcatheter aortic valve implantation for patients with severe bicuspid aortic valve stenosis. Circ Cardiovasc Interv. 2013; 6(3): 284–291.
  19. Kochman J, Huczek Z, Scisło P, et al. Comparison of one- and 12-month outcomes of transcatheter aortic valve replacement in patients with severely stenotic bicuspid versus tricuspid aortic valves (results from a multicenter registry). Am J Cardiol. 2014; 114(5): 757–762.
  20. Nombela-Franco L, Ruel M, Radhakrishnan S, et al. Comparison of hemodynamic performance of self-expandable CoreValve versus balloon-expandable Edwards SAPIEN aortic valves inserted by catheter for aortic stenosis. Am J Cardiol. 2013; 111(7): 1026–1033.
  21. Abdel-Wahab M, Zahn R, Horack M, et al. German transcatheter aortic valve interventions registry investigators. Aortic regurgitation after transcatheter aortic valve implantation: incidence and early outcome. Results from the German transcatheter aortic valve interventions registry. Heart. 2011; 97(11): 899–906.
  22. Leon MB, Smith CR, Mack MJ, et al. PARTNER 2 Investigators, PARTNER Trial Investigators. Two-year outcomes after transcatheter or surgical aortic-valve replacement. N Engl J Med. 2012; 366(18): 1686–1695.
  23. Bauer T, Linke A, Sievert H, et al. Comparison of the effectiveness of transcatheter aortic valve implantation in patients with stenotic bicuspid versus tricuspid aortic valves (from the German TAVI Registry). Am J Cardiol. 2014; 113(3): 518–521.
  24. Yousef A, Simard T, Webb J, et al. Transcatheter aortic valve implantation in patients with bicuspid aortic valve: A patient level multi-center analysis. Int J Cardiol. 2015; 189: 282–288.
  25. Perlman GY, Blanke P, Dvir D, et al. Bicuspid Aortic Valve Stenosis: Favorable Early Outcomes With a Next-Generation Transcatheter Heart Valve in a Multicenter Study. JACC Cardiovasc Interv. 2016; 9(8): 817–824.