The Official Journal of EuroPCR and the European Association of Percutaneous Coronary Interventions (EAPCI)

INTERVENTIONS FOR VALVULAR DISEASE AND HEART FAILURE

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

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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