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Changes in One-Year Mortality in Elderly Patients Admitted with Acute Myocardial Infarction in Relation with Early Management The Impact of Proximal Vessel Tortuosity on the Outcomes of Chronic Total Occlusion Percutaneous Coronary Intervention: Insights From a Contemporary Multicenter Registry Association of Acute Procedural Results with Long-term Outcomes After CTO-PCI De-escalation of antianginal medications after successful chronic total occlusion percutaneous coronary intervention: Frequency and relationship with health status 2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR Guideline for the Evaluation and Diagnosis of Chest Pain: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines Long-term Survival following Multivessel Revascularization in Patients with Diabetes (FREEDOM Follow-On Study) Left Ventricular Assist Device as a Bridge to Recovery for Patients With Advanced Heart Failure Comparison of Stent Expansion Guided by Optical Coherence Tomography Versus Intravascular Ultrasound: The ILUMIEN II Study (Observational Study of Optical Coherence Tomography [OCT] in Patients Undergoing Fractional Flow Reserve [FFR] and Percutaneous Coronary Intervention) Stent fracture is associated with a higher mortality in patients with type-2 diabetes treated by implantation of a second-generation drug-eluting stent Prospective Elimination of Distal Coronary Sinus to Left Atrial Connection for Atrial Fibrillation Ablation (PRECAF) Randomized Controlled Trial

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 gradient20 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) 1.051.20, p = 0.001] and BAV type 0 (OR 11.31, 95% CI 3.4537.06, 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.