Study Compares TAVR Outcomes in Patients With Bicuspid and Tricuspid AS

Patients with bicuspid aortic valve stenosis (AS) who underwent a transcatheter aortic valve replacement (TAVR) had a significantly lower device success rate than those with tricuspid AS, according to a study presented on March 18 during ACC.17 in Washington, DC.

Sung-Han Yoon, MD, et al., stratified the data according to device type and found procedural differences between the two groups treated with early generation devices; however, no differences were found between those treated with new generation devices.

Using the Bicuspid AS TAVR registry, the authors included 561 patients with bicuspid AS treated across 33 participating centers from Europe, North and Asia-Pacific. Data on 4,546 patients with tricuspid AS were collected from 12 participating centers during the same time period, between April 2005 and May 2016. Propensity-score matching assembled 546 pairs of patients with similar baseline characteristics.

Results showed that all-cause mortality rates at the 2-year mark were comparable (17.2 percent bicuspid AS vs. 19.4 percent tricuspid AS). Compared to tricuspid AS patients with early generation devices, bicuspid AS patients had more frequent adverse procedural events (aortic root injury with Sapien XT, 4.5 percent vs. 0.0 percent; p=0.0015; moderate-so-severe paravalvular leak with CoreValve, 19.4 percent vs. 10.5 percent, p=0.02.)

"The accumulation of [a] large multicenter database has for the first time allowed comparisons of matched cohorts, as well as the potential impact of differences in device type," the authors state.

"The new generation devices were developed to mitigate the critical limitations of the early generation devices: significant paravalvular leak, difficulty with optimal positioning, and vascular complications," they add. "The present study showed that the initial attempt of device advancement succeeded in overcoming the procedural limitations in tricuspid AS and now must go beyond the challenges in treating bicuspid AS."

Clinical Topics: Cardiac Surgery, Invasive Cardiovascular Angiography and Intervention, Valvular Heart Disease, Aortic Surgery, Cardiac Surgery and VHD, Interventions and Structural Heart Disease

Keywords: ACC17, ACC Annual Scientific Session, Aortic Valve, Aortic Valve Stenosis, Bicuspid, Comorbidity, Confidence Intervals, Heart Valve Diseases, Registries, Survival Rate, Transcatheter Aortic Valve Replacement

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