Bicuspid aortic valve (BAV) patients undergoing TAVR may encounter more severe brain injuries not only due to greater number of lesions, but also due to larger lesion size in the early phase after TAVR, according to a study published Nov. 23 in the Journal of the American College of Cardiology.

Jiaqi Fan, MD, et al., sought to evaluate the risk of brain injury in BAV patients following TAVR because the risk of brain injury in diffusion-weighted magnetic resonance imaging (DW-MRI) is currently unknown. A total of 204 consecutive severe aortic stenosis patients who underwent TAVR were included in the study, including 83 BAV patients and 121 tricuspid aortic valve (TAV) patients. All patients received DW-MRI at baseline and after TAVR.

Results showed that median ages (76 years vs. 79 years) and Society of Thoracic Surgeons scores (4.87 vs. 6.38) of the BAV and TAV patients were significantly different. The overt stroke rates were comparable between the BAV group and the TAV group (2.4% vs. 1.7%).

BAV patients were associated with a higher number of new lesions (4.0 vs. 2.0), total lesion volume (290 mm³ vs. 140 mm³) and the volume per lesion (70.0 mm³ vs. 57.5 mm³) in DW-MRI. The proportion of patients with lesions larger than 1 cm³ was higher in BAV patients than TAV patients (28.6% vs. 10.9%).

"A significantly higher frequency of larger new cerebral ischemic lesions after TAVR are found in BAV patients in the early phase after TAVR, which needs to be further confirmed by future studies," write the authors.

"[We] concur as physicians with the cautious indications for TAVR in patients with BAVs as implicitly suggested here," write Marc A. Radermecker, MD, PhD, et al., in an accompanying editorial comment. "Indeed, at a time when TAVR appears as a new paradigm for the treatment of severe AS in TAV regardless of the risk category, patients with BAVs deserve special attention for optimal care. They are much younger than their TAV counterparts and are predominantly at lower risk according to current scoring systems. As such, their lifestyle and life expectancy expose them to every unresolved issue of TAVR, namely suboptimal valve deployment and possibly accelerated valve failure, a need for pacemakers, and worrying neurological risk."

Clinical Topics: Cardiac Surgery, Cardiovascular Care Team, Invasive Cardiovascular Angiography and Intervention, Noninvasive Imaging, Valvular Heart Disease, Aortic Surgery, Cardiac Surgery and VHD, Interventions and Imaging, Interventions and Structural Heart Disease, Magnetic Resonance Imaging

Keywords: Heart Valve Diseases, Aortic Valve, Transcatheter Aortic Valve Replacement, Life Expectancy, Aortic Valve Stenosis, Tricuspid Valve, Aorta, Stroke, Cardiology, Brain Injuries, Surgeons, Life Style, Magnetic Resonance Imaging, Pacemaker, Artificial

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