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Transcatheter Aortic-Valve Replacement with a Self-Expanding Valve in Low-Risk Patients Transcatheter Aortic-Valve Replacement with a Balloon-Expandable Valve in Low-Risk Patients Early Versus Standard Discharge After Transcatheter Aortic Valve Replacement: A Systematic Review and Meta-Analysis Preventing Coronary Obstruction During Transcatheter Aortic Valve Replacement From Computed Tomography to BASILICA Surgical or Transcatheter Aortic-Valve Replacement in Intermediate-Risk Patients Transcatheter or Surgical Aortic-Valve Replacement in Intermediate-Risk Patients Transcatheter Laceration of Aortic Leaflets to Prevent Coronary Obstruction During Transcatheter Aortic Valve Replacement: Concept to First-in-Human 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 Transcatheter Versus Surgical Aortic Valve Replacement in Patients With Severe Aortic Valve Stenosis: 1-Year Results From the All-Comers NOTION Randomized Clinical Trial Comparative Accuracy of Focused Cardiac Ultrasonography and Clinical Examination for Left Ventricular Dysfunction and Valvular Heart Disease: A Systematic Review and Meta-analysis
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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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