Interventions for valvular disease and heart failure - Mini focus on transcatheter valve implantation

Three-year outcomes of transcatheter aortic valve implantation for bicuspid versus tricuspid aortic stenosis

EuroIntervention 2022;18:193-202. DOI: 10.4244/EIJ-D-21-00734

Dao Zhou
Dao Zhou1, MD; Abuduwufuer Yidilisi1, MD; Jiaqi Fan1, MD; Yebei Zhang1,2, MD; Hanyi Dai1, MD; Gangjie Zhu1, MD; Yuchao Guo1, MD; Yuxin He1, MD; Qifeng Zhu1, MD; Xinping Lin1, MD; Huajun Li1, MD; Jubo Jiang1, MD; Stella Ng1, MD; Cheng Li1, BS; Kaida Ren1, MD; Lihan Wang1, MD; Xianbao Liu1, MD, PhD; Jian’an Wang1, MD, PhD
1. Department of Cardiology, Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, People’s Republic of China; 2. Department of Cardiology, People's Hospital of Anji, Anji County, Zhejiang, People's Republic of China

Background: Transcatheter aortic valve implantation (TAVI) might be a feasible treatment option for more patients with bicuspid aortic valve (BAV) stenosis. However, long-term follow-up data in this population are scarce.

Aims: The aim of this study was to evaluate three-year outcomes after TAVI in patients with BAV.

Methods: A total of 246 consecutive patients who underwent TAVI at a single centre in China between March 2013 and February 2018 were enrolled in this study. Clinical outcomes, health status and echocardiography were followed and recorded for three years.

Results: Among 109 (44.3%) BAV patients, 61.5% were Type 0 and 36.7% were Type 1 BAV patients. BAV patients were younger (75 vs 77 years, p=0.041) and had a lower Society of Thoracic Surgeons (STS) score (5.09 vs 6.00, p=0.026) compared to tricuspid aortic valve (TAV) patients. There were no differences in three-year survival rates between bicuspid and tricuspid patients (87.1% vs 79.5%, log-rank p=0.126). Multivariate Cox regression analysis adjusting for confounding factors revealed a similar risk of all-cause mortality in the BAV population (hazard ratio [HR] 0.86, 95% confidence interval [CI]: 0.44-1.70, p=0.666). Except for the rate of permanent pacemaker implantation that was lower in BAV patients (11.9% vs 21.9%, p=0.041), the incidence of other clinical adverse events was comparable between the two groups. Both BAV and TAV patients showed an obvious improvement in valve haemodynamics, which was sustained for three years. In addition, similar left ventricular reverse remodelling was found during follow-up.

Conclusions: BAV patients showed similar satisfactory three-year clinical outcomes, persistent valve haemodynamics improvement, and obvious cardiac reverse remodelling after TAVI compared to TAV patients.

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bicuspid aortic valvehaemodynamicslong-term outcomesreverse modellingtranscatheter aortic valve implantation
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