Transcatheter aortic valve implantation for bicuspid aortic valve stenosis: Acute and intermediate-term outcomes in a high volume institution

Anže Djordjević; Giuseppe D'Ancona; Axel Unbehaun; Stephan Kische; Hüseyin Ince; Miralem Pašić

doi:10.6016/ZdravVestn.2175

Anže Djordjević University Clinical Center Maribor, Maribor, Slovenia
Giuseppe D'Ancona Department of Cardiology, Vivantes Klinikum im Friedrichshain und Am Urban, Berlin, Germany, and Rostock University Medical Center, Rostock, Germany
Axel Unbehaun Department of Cardiac Surgery, Deutsches Herzzentrum Berlin, Berlin, Germany
Stephan Kische Department of Cardiology, Vivantes Klinikum im Friedrichshain und Am Urban, Berlin, Germany, and Rostock University Medical Center, Rostock, Germany
Hüseyin Ince Department of Cardiology, Vivantes Klinikum im Friedrichshain und Am Urban, Berlin, Germany, and Rostock University Medical Center, Rostock, Germany
Miralem Pašić Department of Cardiac Surgery, Deutsches Herzzentrum Berlin, Berlin, Germany

DOI: https://doi.org/10.6016/ZdravVestn.2175

Keywords: TAVi, bicuspid, aortic, valve

Abstract

Background: We report our experience with transcatheter aortic valve implantation (TAVI) in patients with bicuspid aortic valve (BAV) stenosis.

Methods: Perioperative and intermediate-term follow-up data were retrospectively analysed. All procedures were performed within the premises of an experienced high-volume TAVI centre.

Results: Tirty-three consecutive BAV patients (age 55 to 87 years) underwent TAVI. Mean logistic European System for Cardiac Operative Risk Evaluation (EuroSCORE) was 23,2 ± 19,3. Transapical Edwards Sapien® valve was implanted in the majority of patients (87.9 %). Nine patients (27.3 %) required post-ballooning of the implanted valve for moderate to severe paravalvular leak, 3 patients (9 %) required a second valve implantation for persistent severe paravalvular leak, and 2 (6 %) required conversion to conventional surgery. Post-operative mild aortic regurgitation (AR) was presented in 12 patients (36.4%) and AR = 2 in 3 %. No AR > 2 was observed. Te device success rate according to the valve academic research consortium (VARC) criteria was 82 %. Similar BAV anatomy, calcium distribution, type and size of implanted valve were noticed in patients with and without residual AR. Tere was no thirty-day mortality. Two-year estimated survival was 70 % (CI: 52.7–93.1) and was similar in patients with and without post-procedural residual paravalvular leak.

Conclusions: TAVI in BAV stenosis is feasible but, even in experienced centres, is technically more challenging and is associated with a higher rate of post-dilatation, re-valving, and conversion to conventional surgery. Results should be re-tested in light of the recent introduction of second-generation TAVI prostheses.

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