Outcomes in Transcatheter Aortic Valve Replacement for Bicuspid Versus Tricuspid Aortic Valve Stenosis

Sung-Han Yoon; Sabine Bleiziffer; Ole De Backer; Victoria Delgado; Takahide Arai; Johannes Ziegelmueller; Marco Barbanti; Rahul Sharma; Gidon Y Perlman; Omar K Khalique; Erik W Holy; Smriti Saraf; Florian Deuschl; Buntaro Fujita; Philipp Ruile; Franz-Josef Neumann; Gregor Pache; Masao Takahashi; Hidehiro Kaneko; Tobias Schmidt; Yohei Ohno; Niklas Schofer; William K F Kong; Edgar Tay; Daisuke Sugiyama; Hiroyuki Kawamori; Yoshio Maeno; Yigal Abramowitz; Tarun Chakravarty; Mamoo Nakamura; Shingo Kuwata; Gerald Yong; Hsien-Li Kao; Michael Lee; Hyo-Soo Kim; Thomas Modine; S Chiu Wong; Francesco Bedgoni; Luca Testa; Emmanuel Teiger; Christian Butter; Stephan M Ensminger; Ulrich Schaefer; Danny Dvir; Philipp Blanke; Jonathon Leipsic; Fabian Nietlispach; Mohamed Abdel-Wahab; Bernard Chevalier; Corrado Tamburino; David Hildick-Smith; Brian K Whisenant; Seung-Jung Park; Antonio Colombo; Azeem Latib; Susheel K. Kodali; Jeroen J Bax; Lars Søndergaard; John G Webb; Thierry Lefèvre; Martin B Leon; Raj R Makkar

doi:10.1016/j.jacc.2017.03.017

Outcomes in Transcatheter Aortic Valve Replacement for Bicuspid Versus Tricuspid Aortic Valve Stenosis

Sung-Han Yoon, Sabine Bleiziffer, Ole De Backer, Victoria Delgado, Takahide Arai, Johannes Ziegelmueller, Marco Barbanti, Rahul Sharma, Gidon Y Perlman, Omar K Khalique, Erik W Holy, Smriti Saraf, Florian Deuschl, Buntaro Fujita, Philipp Ruile, Franz-Josef Neumann, Gregor Pache, Masao Takahashi, Hidehiro Kaneko, Tobias SchmidtYohei Ohno, Niklas Schofer, William K F Kong, Edgar Tay, Daisuke Sugiyama, Hiroyuki Kawamori, Yoshio Maeno, Yigal Abramowitz, Tarun Chakravarty, Mamoo Nakamura, Shingo Kuwata, Gerald Yong, Hsien-Li Kao, Michael Lee, Hyo-Soo Kim, Thomas Modine, S Chiu Wong, Francesco Bedgoni, Luca Testa, Emmanuel Teiger, Christian Butter, Stephan M Ensminger, Ulrich Schaefer, Danny Dvir, Philipp Blanke, Jonathon Leipsic, Fabian Nietlispach, Mohamed Abdel-Wahab, Bernard Chevalier, Corrado Tamburino, David Hildick-Smith, Brian K Whisenant, Seung-Jung Park, Antonio Colombo, Azeem Latib, Susheel K. Kodali, Jeroen J Bax, Lars Søndergaard, John G Webb, Thierry Lefèvre, Martin B Leon, Raj R Makkar

Department of Clinical Medicine

187 Citations (Scopus)

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Abstract

BACKGROUND: Transcatheter aortic valve replacement (TAVR) is being increasingly performed in patients with bicuspid aortic valve stenosis (AS).

OBJECTIVES: This study sought to compare the procedural and clinical outcomes in patients with bicuspid versus tricuspid AS from the Bicuspid AS TAVR multicenter registry.

METHODS: Outcomes of 561 patients with bicuspid AS and 4,546 patients with tricuspid AS were compared after propensity score matching, assembling 546 pairs of patients with similar baseline characteristics. Procedural and clinical outcomes were recorded according to Valve Academic Research Consortium-2 criteria.

RESULTS: Compared with patients with tricuspid AS, patients with bicuspid AS had more frequent conversion to surgery (2.0% vs. 0.2%; p = 0.006) and a significantly lower device success rate (85.3% vs. 91.4%; p = 0.002). Early-generation devices were implanted in 320 patients with bicuspid and 321 patients with tricuspid AS, whereas new-generation devices were implanted in 226 and 225 patients with bicuspid and tricuspid AS, respectively. Within the group receiving early-generation devices, bicuspid AS had more frequent aortic root injury (4.5% vs. 0.0%; p = 0.015) when receiving the balloon-expanding device, and moderate-to-severe paravalvular leak (19.4% vs. 10.5%; p = 0.02) when receiving the self-expanding device. Among patients with new-generation devices, however, procedural results were comparable across different prostheses. The cumulative all-cause mortality rates at 2 years were comparable between bicuspid and tricuspid AS (17.2% vs. 19.4%; p = 0.28).

CONCLUSIONS: Compared with tricuspid AS, TAVR in bicuspid AS was associated with a similar prognosis, but lower device success rate. Procedural differences were observed in patients treated with the early-generation devices, whereas no differences were observed with the new-generation devices.

Original language	English
Journal	Journal of the American College of Cardiology
Volume	69
Issue number	21
Pages (from-to)	2579-2589
Number of pages	11
ISSN	0735-1097
DOIs	https://doi.org/10.1016/j.jacc.2017.03.017
Publication status	Published - 30 May 2017

Keywords

Aged
Aortic Valve/abnormalities
Aortic Valve Stenosis/mortality
Female
Global Health
Heart Valve Diseases/surgery
Heart Valve Prosthesis
Humans
Male
Retrospective Studies
Survival Rate/trends
Transcatheter Aortic Valve Replacement/methods
Treatment Outcome
Tricuspid Valve/abnormalities

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Yoon, S-H., Bleiziffer, S., De Backer, O., Delgado, V., Arai, T., Ziegelmueller, J., Barbanti, M., Sharma, R., Perlman, G. Y., Khalique, O. K., Holy, E. W., Saraf, S., Deuschl, F., Fujita, B., Ruile, P., Neumann, F-J., Pache, G., Takahashi, M., Kaneko, H., ... Makkar, R. R. (2017). Outcomes in Transcatheter Aortic Valve Replacement for Bicuspid Versus Tricuspid Aortic Valve Stenosis. Journal of the American College of Cardiology, 69(21), 2579-2589. https://doi.org/10.1016/j.jacc.2017.03.017

Yoon, S-H, Bleiziffer, S, De Backer, O, Delgado, V, Arai, T, Ziegelmueller, J, Barbanti, M, Sharma, R, Perlman, GY, Khalique, OK, Holy, EW, Saraf, S, Deuschl, F, Fujita, B, Ruile, P, Neumann, F-J, Pache, G, Takahashi, M, Kaneko, H, Schmidt, T, Ohno, Y, Schofer, N, Kong, WKF, Tay, E, Sugiyama, D, Kawamori, H, Maeno, Y, Abramowitz, Y, Chakravarty, T, Nakamura, M, Kuwata, S, Yong, G, Kao, H-L, Lee, M, Kim, H-S, Modine, T, Wong, SC, Bedgoni, F, Testa, L, Teiger, E, Butter, C, Ensminger, SM, Schaefer, U, Dvir, D, Blanke, P, Leipsic, J, Nietlispach, F, Abdel-Wahab, M, Chevalier, B, Tamburino, C, Hildick-Smith, D, Whisenant, BK, Park, S-J, Colombo, A, Latib, A, Kodali, SK, J Bax, J, Søndergaard, L, Webb, JG, Lefèvre, T, Leon, MB & Makkar, RR 2017, 'Outcomes in Transcatheter Aortic Valve Replacement for Bicuspid Versus Tricuspid Aortic Valve Stenosis', Journal of the American College of Cardiology, vol. 69, no. 21, pp. 2579-2589. https://doi.org/10.1016/j.jacc.2017.03.017

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title = "Outcomes in Transcatheter Aortic Valve Replacement for Bicuspid Versus Tricuspid Aortic Valve Stenosis",

abstract = "BACKGROUND: Transcatheter aortic valve replacement (TAVR) is being increasingly performed in patients with bicuspid aortic valve stenosis (AS).OBJECTIVES: This study sought to compare the procedural and clinical outcomes in patients with bicuspid versus tricuspid AS from the Bicuspid AS TAVR multicenter registry.METHODS: Outcomes of 561 patients with bicuspid AS and 4,546 patients with tricuspid AS were compared after propensity score matching, assembling 546 pairs of patients with similar baseline characteristics. Procedural and clinical outcomes were recorded according to Valve Academic Research Consortium-2 criteria.RESULTS: Compared with patients with tricuspid AS, patients with bicuspid AS had more frequent conversion to surgery (2.0% vs. 0.2%; p = 0.006) and a significantly lower device success rate (85.3% vs. 91.4%; p = 0.002). Early-generation devices were implanted in 320 patients with bicuspid and 321 patients with tricuspid AS, whereas new-generation devices were implanted in 226 and 225 patients with bicuspid and tricuspid AS, respectively. Within the group receiving early-generation devices, bicuspid AS had more frequent aortic root injury (4.5% vs. 0.0%; p = 0.015) when receiving the balloon-expanding device, and moderate-to-severe paravalvular leak (19.4% vs. 10.5%; p = 0.02) when receiving the self-expanding device. Among patients with new-generation devices, however, procedural results were comparable across different prostheses. The cumulative all-cause mortality rates at 2 years were comparable between bicuspid and tricuspid AS (17.2% vs. 19.4%; p = 0.28).CONCLUSIONS: Compared with tricuspid AS, TAVR in bicuspid AS was associated with a similar prognosis, but lower device success rate. Procedural differences were observed in patients treated with the early-generation devices, whereas no differences were observed with the new-generation devices.",

keywords = "Aged, Aortic Valve/abnormalities, Aortic Valve Stenosis/mortality, Female, Global Health, Heart Valve Diseases/surgery, Heart Valve Prosthesis, Humans, Male, Retrospective Studies, Survival Rate/trends, Transcatheter Aortic Valve Replacement/methods, Treatment Outcome, Tricuspid Valve/abnormalities",

author = "Sung-Han Yoon and Sabine Bleiziffer and {De Backer}, Ole and Victoria Delgado and Takahide Arai and Johannes Ziegelmueller and Marco Barbanti and Rahul Sharma and Perlman, {Gidon Y} and Khalique, {Omar K} and Holy, {Erik W} and Smriti Saraf and Florian Deuschl and Buntaro Fujita and Philipp Ruile and Franz-Josef Neumann and Gregor Pache and Masao Takahashi and Hidehiro Kaneko and Tobias Schmidt and Yohei Ohno and Niklas Schofer and Kong, {William K F} and Edgar Tay and Daisuke Sugiyama and Hiroyuki Kawamori and Yoshio Maeno and Yigal Abramowitz and Tarun Chakravarty and Mamoo Nakamura and Shingo Kuwata and Gerald Yong and Hsien-Li Kao and Michael Lee and Hyo-Soo Kim and Thomas Modine and Wong, {S Chiu} and Francesco Bedgoni and Luca Testa and Emmanuel Teiger and Christian Butter and Ensminger, {Stephan M} and Ulrich Schaefer and Danny Dvir and Philipp Blanke and Jonathon Leipsic and Fabian Nietlispach and Mohamed Abdel-Wahab and Bernard Chevalier and Corrado Tamburino and David Hildick-Smith and Whisenant, {Brian K} and Seung-Jung Park and Antonio Colombo and Azeem Latib and Kodali, {Susheel K.} and {J Bax}, Jeroen and Lars S{\o}ndergaard and Webb, {John G} and Thierry Lef{\`e}vre and Leon, {Martin B} and Makkar, {Raj R}",

year = "2017",

month = may,

day = "30",

doi = "10.1016/j.jacc.2017.03.017",

language = "English",

volume = "69",

pages = "2579--2589",

journal = "Journal of the American College of Cardiology",

issn = "0735-1097",

publisher = "Elsevier",

number = "21",

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TY - JOUR

T1 - Outcomes in Transcatheter Aortic Valve Replacement for Bicuspid Versus Tricuspid Aortic Valve Stenosis

AU - Yoon, Sung-Han

AU - Bleiziffer, Sabine

AU - De Backer, Ole

AU - Delgado, Victoria

AU - Arai, Takahide

AU - Ziegelmueller, Johannes

AU - Barbanti, Marco

AU - Sharma, Rahul

AU - Perlman, Gidon Y

AU - Khalique, Omar K

AU - Holy, Erik W

AU - Saraf, Smriti

AU - Deuschl, Florian

AU - Fujita, Buntaro

AU - Ruile, Philipp

AU - Neumann, Franz-Josef

AU - Pache, Gregor

AU - Takahashi, Masao

AU - Kaneko, Hidehiro

AU - Schmidt, Tobias

AU - Ohno, Yohei

AU - Schofer, Niklas

AU - Kong, William K F

AU - Tay, Edgar

AU - Sugiyama, Daisuke

AU - Kawamori, Hiroyuki

AU - Maeno, Yoshio

AU - Abramowitz, Yigal

AU - Chakravarty, Tarun

AU - Nakamura, Mamoo

AU - Kuwata, Shingo

AU - Yong, Gerald

AU - Kao, Hsien-Li

AU - Lee, Michael

AU - Kim, Hyo-Soo

AU - Modine, Thomas

AU - Wong, S Chiu

AU - Bedgoni, Francesco

AU - Testa, Luca

AU - Teiger, Emmanuel

AU - Butter, Christian

AU - Ensminger, Stephan M

AU - Schaefer, Ulrich

AU - Dvir, Danny

AU - Blanke, Philipp

AU - Leipsic, Jonathon

AU - Nietlispach, Fabian

AU - Abdel-Wahab, Mohamed

AU - Chevalier, Bernard

AU - Tamburino, Corrado

AU - Hildick-Smith, David

AU - Whisenant, Brian K

AU - Park, Seung-Jung

AU - Colombo, Antonio

AU - Latib, Azeem

AU - Kodali, Susheel K.

AU - J Bax, Jeroen

AU - Søndergaard, Lars

AU - Webb, John G

AU - Lefèvre, Thierry

AU - Leon, Martin B

AU - Makkar, Raj R

PY - 2017/5/30

Y1 - 2017/5/30

N2 - BACKGROUND: Transcatheter aortic valve replacement (TAVR) is being increasingly performed in patients with bicuspid aortic valve stenosis (AS).OBJECTIVES: This study sought to compare the procedural and clinical outcomes in patients with bicuspid versus tricuspid AS from the Bicuspid AS TAVR multicenter registry.METHODS: Outcomes of 561 patients with bicuspid AS and 4,546 patients with tricuspid AS were compared after propensity score matching, assembling 546 pairs of patients with similar baseline characteristics. Procedural and clinical outcomes were recorded according to Valve Academic Research Consortium-2 criteria.RESULTS: Compared with patients with tricuspid AS, patients with bicuspid AS had more frequent conversion to surgery (2.0% vs. 0.2%; p = 0.006) and a significantly lower device success rate (85.3% vs. 91.4%; p = 0.002). Early-generation devices were implanted in 320 patients with bicuspid and 321 patients with tricuspid AS, whereas new-generation devices were implanted in 226 and 225 patients with bicuspid and tricuspid AS, respectively. Within the group receiving early-generation devices, bicuspid AS had more frequent aortic root injury (4.5% vs. 0.0%; p = 0.015) when receiving the balloon-expanding device, and moderate-to-severe paravalvular leak (19.4% vs. 10.5%; p = 0.02) when receiving the self-expanding device. Among patients with new-generation devices, however, procedural results were comparable across different prostheses. The cumulative all-cause mortality rates at 2 years were comparable between bicuspid and tricuspid AS (17.2% vs. 19.4%; p = 0.28).CONCLUSIONS: Compared with tricuspid AS, TAVR in bicuspid AS was associated with a similar prognosis, but lower device success rate. Procedural differences were observed in patients treated with the early-generation devices, whereas no differences were observed with the new-generation devices.

AB - BACKGROUND: Transcatheter aortic valve replacement (TAVR) is being increasingly performed in patients with bicuspid aortic valve stenosis (AS).OBJECTIVES: This study sought to compare the procedural and clinical outcomes in patients with bicuspid versus tricuspid AS from the Bicuspid AS TAVR multicenter registry.METHODS: Outcomes of 561 patients with bicuspid AS and 4,546 patients with tricuspid AS were compared after propensity score matching, assembling 546 pairs of patients with similar baseline characteristics. Procedural and clinical outcomes were recorded according to Valve Academic Research Consortium-2 criteria.RESULTS: Compared with patients with tricuspid AS, patients with bicuspid AS had more frequent conversion to surgery (2.0% vs. 0.2%; p = 0.006) and a significantly lower device success rate (85.3% vs. 91.4%; p = 0.002). Early-generation devices were implanted in 320 patients with bicuspid and 321 patients with tricuspid AS, whereas new-generation devices were implanted in 226 and 225 patients with bicuspid and tricuspid AS, respectively. Within the group receiving early-generation devices, bicuspid AS had more frequent aortic root injury (4.5% vs. 0.0%; p = 0.015) when receiving the balloon-expanding device, and moderate-to-severe paravalvular leak (19.4% vs. 10.5%; p = 0.02) when receiving the self-expanding device. Among patients with new-generation devices, however, procedural results were comparable across different prostheses. The cumulative all-cause mortality rates at 2 years were comparable between bicuspid and tricuspid AS (17.2% vs. 19.4%; p = 0.28).CONCLUSIONS: Compared with tricuspid AS, TAVR in bicuspid AS was associated with a similar prognosis, but lower device success rate. Procedural differences were observed in patients treated with the early-generation devices, whereas no differences were observed with the new-generation devices.

KW - Aged

KW - Aortic Valve/abnormalities

KW - Aortic Valve Stenosis/mortality

KW - Female

KW - Global Health

KW - Heart Valve Diseases/surgery

KW - Heart Valve Prosthesis

KW - Humans

KW - Male

KW - Retrospective Studies

KW - Survival Rate/trends

KW - Transcatheter Aortic Valve Replacement/methods

KW - Treatment Outcome

KW - Tricuspid Valve/abnormalities

U2 - 10.1016/j.jacc.2017.03.017

DO - 10.1016/j.jacc.2017.03.017

M3 - Journal article

C2 - 28330793

SN - 0735-1097

VL - 69

SP - 2579

EP - 2589

JO - Journal of the American College of Cardiology

JF - Journal of the American College of Cardiology

IS - 21

ER -

Outcomes in Transcatheter Aortic Valve Replacement for Bicuspid Versus Tricuspid Aortic Valve Stenosis

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