CharActeristics, sizing anD outcomes of stenotic, tapered, rapHe-type bicuspid aOrtic valves treated with trans-catheter device implantation: Insights the AD HOC registry.

Alessandro Mazzapicchi, Marianna Adamo, Lin Bai, Takashi Nagasaka, Ofir Koren, Andrea Buono, Chiara De Biase, Tommaso Fabris, Michele Bellamoli, Nicholas Montarello, Mesfer Alfadhel, Simone Fezzi, Barbara Bellini, Mauro Massussi, Giuseppe Tarantini, Enrico Giacomin, Riccardo Gorla, Alessia Latini, Orazio Strazzieri, Mauro Boiago, Marco Busco, Efstratios Charitos, Ady Orbach, Edoardo Navazio, Donato Antonio Paglianiti, Massimo Napodano, Luca Favero, Didier Tchètchè, Marco Barbanti, Anna Sonia Petronio, Nedy Brambilla, Giuliano Costa, Luca Bettari, Chiara Fraccaro, Azeem Latib, Matteo Montorfano, Emmanuel Villa, Antonio Messina, Francesco Bedogni, Daniel J Blackman, Antonio Mangieri, Won-Keun Kim, Andrea Zito, Uri Landes, Lars Sondergaard, Raj R Makkar, Mao Chen, Alfonso Ielasi, Marco Angelillis, Ole De Backer, Diego Maffeo, Francesco Saia, Andrea Scotti, Darren Mylotte, Giulia Costa

Journal: International journal of cardiology 2024;417():132569

PMID: 39303924

Full Text on Elsevier Science View on PubMed

Abstract

BACKGROUND

Raphe-type bicuspid aortic valve (BAV) is a potential hostile scenario in trans-catheter aortic valve replacement (TAVR) due to pronounced calcium burden, possibly associated with tapered valve configuration. Trans-Catheter heart valve (THV) sizing strategy (annular vs. supra-annular) is controversial in this valve subtype.

OBJECTIVES

To describe the phenotypical characteristics of severe, tapered, raphe-type, BAV stenosis undergoing TAVR and to explore safety and efficacy of modern-generation THVs, analysing the impact of annular and supra-annular sizing strategies on short- and mid-terms outcomes.

METHODS

This is a retrospective, multicenter registry enrolling consecutive stenotic Sievers type 1 BAV treated with TAVR. Study population was divided into tapered and non-tapered configuration according to MSCT analysis. Matched comparison between annular and supra-annular sizing groups was performed in tapered population.

RESULTS

From January 2016 to June 2023, 897 patients were enrolled. Of them, 696 patients displayed a tapered configuration. Of those, 510 received a THV according to annular sizing. After propensity score matching 186 matched pairs were selected. Technical success (96.2 % vs 94.1 %, OR 1.61 [0.61-4.24], p = 0.34), 30-day device success (83.6 % in both groups, OR 1.42 [0.78-2.57], p = 0.25) and 30-day early safety (71.8 % vs 70.5 %, OR 1.07 [0.68-1.68], p = 0.78) were similar between the annular and supra-annular sizing groups; a higher post-TAVR gradient was observed in supra-annular group, although it was only 2 mmHg mean. At mid-term follow-up, the rate of clinical efficacy was 84.7 %.

CONCLUSIONS

TAVR with modern-generation devices is safe and effective for tapered raphe-type BAV, showing comparable results for annular and supra-annular sizing strategies.

Address: Valve Center, Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy.; Clinique Pasteur, Toulouse, France.; Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padua Medical School, Padua, Italy.; Kerckhoff Heart Center, Bad Nauheim, Germany.; The Heart Center, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.; U.O.C. Cardiologia, Centro Alte Specialità e Trapianti, P.O. G. Rodolico, A.O.U. Policlinico-V. Emanuele, Università di Catania, Catania, Italy.; Valve Center, Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy; Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome, Italy.; Department of Cardiology, Leeds Teaching Hospitals NHS Trust Leeds, UK.; Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, United States of America.; Department of Cardiology, University Hospitals Galway, Ireland.; Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy.; Civil Hospital and University of Brescia, Brescia, Italy.; Montefiore Medical Center, New York, NY, USA.; Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China.; Cardiac Catheterization Laboratory, University of Pisa and Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy.; Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.; Cardiology Unit, Cardio-Neuro-Vascular Department, Ca' Foncello Hospital Azienda N 2 Marca Trevigiana, Treviso, Italy.; Department of Cardiology, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy.; Cardio Center, IRCCS Humanitas Research Hospital, Rozzano-Milan, Italy.; The Heart Center, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark; Abbott Structural Heart, Santa Clara, CA, USA.; Edith Wolfson Medical Center, Cardiology Department, Holon, Israel and Tel-Aviv University, Tel-Aviv, Israel.; Division of Cardiology, IRCCS Hospital Galeazzi-Sant'Ambrogio, Milan, Italy.; Università degli Studi di Enna "Kore", Enna, Italy.; Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padua Medical School, Padua, Italy. Electronic address: [email protected].

DOI: 10.1016/j.ijcard.2024.132569

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MeSH Terms: Aged, Aged, 80 and over, Female, Humans, Male, Aortic Valve, Aortic Valve Stenosis, Bicuspid Aortic Valve Disease, Follow-Up Studies, Heart Valve Prosthesis, Prosthesis Design, Registries, Retrospective Studies, Transcatheter Aortic Valve Replacement, Treatment Outcome