Transcatheter aortic valve implantation using the ACURATE neo in bicuspid and tricuspid aortic valve stenosis: a propensity-matched analysis of a European experience

EuroIntervention 2018;14:e1269-e1275 published online October 2018. DOI: 10.4244/EIJ-D-18-00281

Antonio Mangieri
Antonio Mangieri1, MD; Alaide Chieffo1*, MD; Kim Won-Keun2, MD; Giulio G. Stefanini3, MD; Giuseppe Rescigno4, MD; Marco Barbanti5, MD; Corrado Tamburino5, MD; Andreas Ruck6, MD; Matteo Pagnesi1, MD; Rickard Linder6, MD; Stefan Toggweiler7, MD; Matteo Montorfano1, MD; Antonio Colombo1, MD
1. Interventional Cardiology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy; 2. Department of Cardiology, Kerckhoff Heart and Lung Center, Bad Nauheim, Germany; 3. Division of Cardiology, Cardio Center, Humanitas Research Hospital, Rozzano, Milan, Italy; 4. Cardiac Surgery Division, Lancisi Cardiological Hospital, Ancona, Italy; 5. Division of Interventional Cardiology, Ferrarotto Hospital, Catania, Italy; 6. Karolinska Institute, Stockholm, Sweden; 7. Heart Center, Luzerner Kantonsspital, Lucerne, Switzerland

Aims: The aim of this study was to assess the performance of a self-expanding valve in bicuspid aortic valve (BAV) stenosis.

Methods and results: An international registry included a total of 712 patients with aortic stenosis treated with the ACURATE neo in bicuspid (n=54; 7.5%) or tricuspid (n=658; 92.4%) anatomy. The overall mean age was 81±5.6 years. At baseline, no significant differences were found between the two groups. BAV more frequently required both predilatation (94.4% vs. 78.1%, p=0.004) and post-dilation (57.4% vs. 38.7%, p=0.007). Moderate perivalvular regurgitation was more frequently found in patients with BAV (7.4% vs. 3.18%, p=0.0001). After propensity score matching (PSM), the rate of predilation and post-dilation was confirmed to be higher in the BAV group (94.4% vs. 66.6%, p=0.001, and 57.4% vs. 37.1%, p=0.034, respectively), while the incidence of moderate perivalvular regurgitation was similar between the two groups (BAV 3.1% vs. 5.5% in tricuspid anatomy, p=0.734). In unmatched cohorts, the 30-day outcome showed a higher rate of stroke in the BAV group (7.4% vs. 1.8%, p=0.001). After adjustment for PSM quintiles, the rate of stroke resulted in being similar (odds ratioadj 1.20, 95% confidence interval [CI]: 0.81-1.76, p=0.819). The other 30-day clinical endpoints were similar between the two populations.

Conclusions: This preliminary analysis shows that the use of the ACURATE neo in bicuspid aortic valves is feasible and has acceptable 30-day outcomes. Larger studies are needed to confirm our preliminary findings.

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