Abstract
Bicuspid aortic valve (BAV) is the most common valvular congenital anomaly and is apparent in nearly 50% of candidates for AV replacement. While transcatheter aortic valve implantation (TAVI) is a recommended treatment for patients with symptomatic severe aortic stenosis (AS) at all surgical risk levels, experience with TAVI in severe bicuspid AS is limited. TAVI in BAV is still a challenge due to its association with multiple and complex anatomical considerations. A retrospective study has been conducted to investigate TAVI’s procedural and 30-day outcomes using the Myval transcatheter heart valve (THV) (Meril Life Sciences Pvt. Ltd. Vapi, Gujarat, India) in patients with severe bicuspid AS. Data were collected on 68 patients with severe bicuspid AS who underwent TAVI with the Myval THV. Baseline characteristics, procedural, 30-day echocardiographic and clinical outcomes were collected. The mean age and STS PROM score were 72.6 ± 9.4 and 3.54 ± 2.1. Procedures were performed via the transfemoral route in 98.5%. Major vascular complications (1.5%) and life-threatening bleeding (1.5%) occurred infrequently. No patient had coronary obstruction, second valve implantation or conversion to surgery. On 30-day echocardiography, the mean transvalvular gradient and effective orifice area were 9.8 ± 4.5 mmHg and 1.8 ± 0.4 cm2, respectively. None/trace aortic regurgitation occurred in 76.5%, mild AR in 20.5% and moderate AR in 3%. The permanent pacemaker implantation rate was 8.5% and 30-day all-cause death occurred in 3.0% of cases. TAVI with the Myval THV in selected BAV anatomy is associated with favorable short-term hemodynamic and clinical outcomes.
Highlights
Bicuspid aortic valve (BAV) is the most common valvular congenital anomaly occurring in up to 1.5% of the general population [1]
The left ventricular (LV) systolic function and device hemodynamic assessments including the severity of paravalvular aortic regurgitation (AR) were assessed and graded using transthoracic echocardiography (TTE) according to established guidelines [14–18]
Data are presented as mean ± standard deviation (SD) or number (n) and frequency (%)
Summary
Bicuspid aortic valve (BAV) is the most common valvular congenital anomaly occurring in up to 1.5% of the general population [1]. Approximately 50% of patients with aortic valve (AV) dysfunction and indicated for aortic valve replacement (AVR) have BAV anatomy [2]. The recent ACC/AHA and ESC guidelines have recommended transcatheter aortic valve implantation (TAVI) as a viable and alternative treatment to surgical aortic valve replacement (SAVR) for selected patients with severe AS. The selection of the most appropriate THV device and size is challenging in BAV due to the unpredictable baseline anatomy. In a recent paper by Kawashima et al [9], operators from real-world practice opted for intermediate size selection in approximately half of the patients treated with TAVI using the BEV Myval (Meril Life Sciences Pvt. Ltd., India). We sought to investigate the procedural outcomes in addition to 30-day safety and performance of TAVI using the Myval THV in patients with severe bicuspid AS
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