A Bicuspid Aortic Valve Imaging Classification for the TAVR Era

• Published in: JACC. Cardiovascular imaging Vol. 9; no. 10; pp. 1145 - 1158
• Main Authors: Jilaihawi, Hasan, MD, Chen, Mao, MD, Webb, John, MD, Himbert, Dominique, MD, Ruiz, Carlos E., MD, Rodés-Cabau, Josep, MD, Pache, Gregor, MD, Colombo, Antonio, MD, Nickenig, Georg, MD, Lee, Michael, MD, Tamburino, Corrado, MD, Sievert, Horst, MD, Abramowitz, Yigal, MD, Tarantini, Giuseppe, MD, Alqoofi, Faisal, MD, Chakravarty, Tarun, MD, Kashif, Mohammad, MD, Takahashi, Nobuyuki, MD, Kazuno, Yoshio, MD, Maeno, Yoshio, MD, Kawamori, Hiroyuki, MD, Chieffo, Alaide, MD, Blanke, Philipp, MD, Dvir, Danny, MD, Ribeiro, Henrique Barbosa, MD, Feng, Yuan, MD, Zhao, Zhen-Gang, MD, Sinning, Jan-Malte, MD, Kliger, Chad, MD, Giustino, Gennaro, MD, Pajerski, Basia, MD, Imme, Sebastiano, MD, Grube, Eberhard, MD, Leipsic, Jonathon, MD, Vahanian, Alec, MD, Michev, Iassen, MD, Jelnin, Vladimir, MD, Latib, Azeem, MD, Cheng, Wen, MD, Makkar, Raj, MD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-10-2016
• Subjects: Aged; Aged, 80 and over; aortic stenosis; Aortic Valve - abnormalities; Aortic Valve - diagnostic imaging; Aortic Valve - physiopathology; Aortic Valve - surgery; aortic valve replacement; Aortic Valve Stenosis - classification; Aortic Valve Stenosis - diagnostic imaging; Aortic Valve Stenosis - physiopathology; Aortic Valve Stenosis - surgery; Asia; bicuspid aortic valve; Bicuspid Aortic Valve Disease; Canada; Cardiovascular; Europe; Female; Heart Valve Diseases - classification; Heart Valve Diseases - diagnostic imaging; Heart Valve Diseases - physiopathology; Heart Valve Diseases - surgery; Humans; Male; Multidetector Computed Tomography; Predictive Value of Tests; TAVI; TAVR; transcatheter aortic valve implantation; Transcatheter Aortic Valve Replacement; Treatment Outcome; United States; Canada; Asia; United States; Europe; transcatheter aortic valve implantation; computed tomography; PAR; Hounsfield unit; aortic valve replacement; paravalvular regurgitation; trileaflet aortic valve; TAVI; TAV; PPM; HU; TAVR; MPR; permanent pacemaker; CT; aortic stenosis; bicuspid aortic valve; BAV; transcatheter aortic valve replacement; multiplanar reformatted
• ISSN: 1936-878X; 1876-7591
• DOI: 10.1016/j.jcmg.2015.12.022

Abstract Objectives This study sought to evaluate transcatheter aortic valve replacement (TAVR) in bicuspid aortic valve (BAV) aortic stenosis (AS), with a particular emphasis on TAVR-directed bicuspid aortic valve imaging (BAVi) of morphological classification. Background TAVR has been used to treat BAV-AS but with heterogeneous outcomes and uncertainty regarding the relevance of morphology. Methods In 14 centers in the United States, Canada, Europe, and Asia, 130 BAV-AS patients underwent TAVR. Baseline cardiac computed tomography (CT) was analyzed by a dedicated Corelab. Outcomes were assessed in line with Valve Academic Research Consortium criteria. Results Bicommissural BAV (vs. tricommissural) accounted for 68.9% of those treated in North America, 88.9% in Europe, and 95.5% in Asia (p = 0.003). For bicommissural bicuspids, non-raphe type (vs. raphe type) BAV accounted for 11.9% of those treated in North America, 9.4% in Europe, and 61.9% in Asia (p < 0.001). Overall rates of 30-day mortality (3.8%) and cerebrovascular events (3.2%) were favorable and similar among anatomical subsets. The rate of new permanent pacemaker insertion was high (26.2%) and similar between balloon-expandable (BE) and self-expanding (SE) designs (BE: 25.5% vs. SE: 26.9%; p = 0.83); there was a trend to greater permanent pacemaker insertion in BE TAVR in the presence of coronary cusp fusion BAV morphology. Paravalvular aortic regurgitation (PAR) ≥ moderate was 18.1% overall but lower at 11.5% in those with pre-procedural CT. In the absence of pre-procedural CT, there was an excess of PAR in BE TAVR that was not the case in those with a pre-procedural CT; SE TAVR required more post-dilation. Predictors of PAR included intercommissural distance for bicommissural bicuspids (odd ratio [OR]: 1.37; 95% confidence interval [CI]: 1.02 to 1.84; p = 0.036) and lack of a baseline CT for annular measurement (OR: 3.03; 95% CI: 1.20 to 7.69; p = 0.018). Conclusions In this multicenter study, TAVR achieved favorable outcomes in patients with pre-procedural CT, with the exception of high permanent pacemaker rates for all devices and shapes.