Tricuspid Aortic Valve Stenosis Research Articles

The first clinical data of the SAPIEN 3 aortic valve in the treatment of aortic stenosis in China.

Data on outcomes following transcatheter aortic valve replacement with SAPIEN 3 in China is limited as it was approved by the National Medical Products since 2020. The present study was designed to collect clinical data on the SAPIEN 3 aortic valve in Chinese patients with bicuspid aortic valve and tricuspid aortic valve stenosis. We analyzed the patient characteristics, procedural features and procedural outcomes of the first 438 patients (223 for bicuspid aortic valve and 215 tricuspid aortic valve) from 21 provinces in 74 sites treated with the SAPIEN 3 valve system for transcatheter aortic valve replacement between September 2020 and May 2022. Procedural mortality was 0.7%. 5 cases during the operation were converted to surgery. Among 438 cases, permanent pacemaker implantation was performed in a total of 12 cases (2.7%). The patient had severe leaflet calcification of the aortic valve, with moderate and severe calcification reaching 39.7% and 35.2% respectively. The size of the implanted valves was predominantly 26 mm and 23 mm, reaching 42.5% and 39.5% respectively. The incidence of moderate or severe perivalvular leak in the postoperative period was 0.5%, with a predominance of 90/10 and 80/20 valve deployment height. There was a significant difference in the deployment height of the valve between bicuspid aortic valve and tricuspid aortic valve, with the bicuspid aortic valve having a more deployment height of 90/10. Annulus size in bicuspid aortic valve group was significantly larger than tricuspid aortic valve group. Valve sizing for oversized, within size, and undersized were different between bicuspid aortic valve and tricuspid aortic valve. Procedural success rates were high, with similar and good results for bicuspid aortic valve and tricuspid aortic valve, low perivalvular leak for both valve types, and low permanent pacemaker implantation rates for both valve types. Annulus size, valve sizing and coronary artery height were significantly different in the BAV and TAV group.

Transcatheter Aortic Valve Replacement for Bicuspid vs. Tricuspid Aortic Stenosis among Patients at Low Surgical Risk in China: From the Multicenter National NTCVR Database.

This study aims to compare the outcomes of transcatheter aortic valve replacement (TAVR) with self-expandable valves for bicuspid aortic valve (BAV) vs. tricuspid aortic valve (TAV) stenosis patients who are at low surgical risk. Participants were enrolled from 36 centers in China between January 2017 and December 2021. The primary endpoint event was all-cause mortality and all stroke at 30 days. Among 389 patients at low surgical risk that underwent TAVR, 229 patients were BAV stenosis (mean age, 72.9 years; 65.1% men). There was no significant difference in the rate of all-cause death between two populations at 30 days. However, the rate of all stroke was significantly higher in the BAV group at 30 days (3.3% vs. 0%; odds ratio (OR), 0.97 (95% confidence interval (CI), 0.94 to 0.99); p = 0.044). By multivariate logistic regression analysis, trans-carotid access was associated with a higher all stroke rate at 30 days (OR, 29.20 (95% CI, 3.97 to 215.1); p = 0.001). In this national registry-based study, patients treated for BAV vs. TAV stenosis had no significant difference in all-cause mortality at 30 days, but trans-carotid access was associated with a higher all stroke rate after TAVR at 30 days.

Propensity-Matched Outcomes Comparing TAVR in Bicuspid vs Surgery in Tricuspid Aortic Valve Stenosis

<h2>Abstract</h2><h3>Objective</h3> To compare 1-year outcomes in patients at low surgical risk with bicuspid aortic valve stenosis (AS) following transcatheter aortic valve replacement (TAVR) and low-risk patients with tricuspid AS following surgical aortic valve replacement (SAVR). <h3>Background</h3> The pivotal randomized, prospective, multicenter TAVR trials compared TAVR vs SAVR in patients with tricuspid AS patients. No such trials exist for bicuspid AS. <h3>Methods</h3> The Low Risk Bicuspid Study is a prospective, single-arm, TAVR trial that enrolled 150 patients from 25 sites in the United States. A screening committee confirmed bicuspid anatomy and valve classification based on computed tomography using the Sievers classification. Annular measurements guided valve sizing. These patients were propensity-matched to the SAVR patients in the randomized Evolut Low Risk Trial using 1:1 5-to-1-digit Greedy method, resulting in 144 matched pairs. For both trials, an independent clinical events committee adjudicated all serious adverse events, and the same independent core laboratory assessed all echocardiograms. <h3>Results</h3> The 1-year composite of death, disabling stroke, or aortic valve–related rehospitalization for bicuspid TAVR vs tricuspid SAVR was 6 (4.2%) vs 6 (4.2%) (<i>P</i> = .99). The effective orifice area (2.2 ± 0.7 cm² vs 2.0 ± 0.6 cm²) was larger and the valve gradient was lower (8.7 ± 3.9 mm Hg vs 11.2 ± 4.7 mm Hg) in the TAVR group at 1 year (both <i>P</i> < .001). Moderate/severe aortic regurgitation was present in 1 TAVR and 2 SAVR patients (0.8% vs 1.6%; <i>P</i> > .99). <h3>Conclusions</h3> In this select group of low-risk bicuspid patients, in the short-term follow-up, TAVR appears to have similar outcomes to those seen in comparable low-risk tricuspid patients undergoing SAVR.

Clinical outcomes of bicuspid versus tricuspid aortic valve stenosis after transcatheter aortic valve replacement with self-expandable valves

BackgroundThere is a lack of available data on specific prognostic comparisons between transcatheter aortic valve replacement (TAVR) using self-expandable valves (SEV) in patients with stenotic Type 0, Type 1 bicuspid aortic valve (BAV) and tricuspid aortic valve (TAV).ObjectivesTo evaluate the association between aortic valve morphology and outcomes following self-expandable TAVR.MethodsConsecutive patients with aortic stenosis(AS) undergoing self-expandable TAVR were enrolled and categorized into three groups (Type 0/Type 1 BAV or TAV) according to the Sievers classification. The primary endpoint was a composite of all-cause mortality and rehospitalization for heart failure (HF) within 2 years. Secondary outcomes included procedural complications and major cardiovascular events observed in clinical follow-ups. Clinical outcomes at 2 years following TAVR were compared among three groups using Kaplan-Meier curve and multivariable Cox proportional hazards regression models.ResultsA total of 344 AS patients (Type 0: 86; Type 1: 109; TAV: 149) were enrolled. The presence of moderate or severe paravalvular leak (PVL) was significantly higher in patients with Type 0 and Type 1 BAV versus TAV (10.47% vs. 16.51% vs. 6.71%, p = 0.043). All-cause 30-day mortality (2.33% vs. 0.92% vs. 2.68%, p = 0.626) and 2-year mortality (3.49% vs. 5.50% vs. 6.71%, p = 0.657) was comparable among the three groups. However, rehospitalization for HF within 2 years was significantly higher in Type 1 BAV (11.63% vs. 20.18% vs. 8.72%, p = 0.020). Multivariate Cox analysis showed that a higher STS score, Type 1 BAV morphology and excess leaflet calcification (≥ median calcium volume (CV) of the entire population) were independent predictors for HF rehospitalization. Additional intragroup Kaplan‒Meier analysis showed that excess leaflet calcification could predict higher long-term mortality and rehospitalization risk for HF(HR (95% CI): 3.430 (1.166–10.090), log rank p = 0.017) in Type 1 BAV patients.ConclusionOutcomes of self-expandable TAVR in BAV-AS patients might vary depending on valve subtypes. BAV patients with excess leaflet calcification and a raphe, especially calcified, had an increased risk of moderate PVL and HF readmission in mid-to-long term follow-ups.

Abstract 14407: Clinical Outcomes of Transcatheter Aortic Valve Replacement in Patients With Bicuspid versus Tricuspid Aortic Valve Stenosis

Introduction: Transcatheter aortic valve replacement (TAVR) has proven to be safe and efficacious in patients with tricuspid aortic valve (TAV) stenosis. However, due to its anatomic complexity, bicuspid aortic valve (BAV) stenosis has been excluded from previous trials, and data remain limited regarding TAVR in this group of patients. Methods: We searched the databases systematically for relevant studies from inception to March 2022. The primary focus was all-cause mortality at 1-year. Additional outcomes included 30-day mortality, 30-day stroke, and 30-day major vascular complications. Results: We included 28 studies with a total of 346,033 patients who underwent TAVR, of which 17,835 patients had BAV stenosis. The risks of 1-year mortality and 30-day major vascular complications were similar between the 2 groups. However, patients with BAV who underwent TAVR had a higher risk of 30-days mortality (BAV 2.3% vs TAV 2.2%, p=0.02) and 30-day stroke (BAV 2.2% vs TAV 1.8%, p=0.01). A subgroup analysis of 23,623 matched patients of whom 49.5% had BAV stenosis was performed. The risk of 1-year mortality was lower in patients with BAV compared to TAV (BAV 5.8% vs TAV 6.8%, p=0.009). Risks of 30-day mortality, and 30-day major vascular complication were similar between the two groups. However, the risk of 30-day stroke was higher in the BAV group (BAV 2.2% vs TAV 1.7%, p=0.02). Conclusions: In our meta-analysis, among patients who underwent TAVR for aortic stenosis, there was no significant difference between BAV vs TAV in outcomes, except for higher risk of 30-days mortality and stroke. Among matched groups, patients with BAV stenosis undergoing TAVR had comparable outcomes to patients with TAV stenosis except for higher risk of stroke and lower risk of 1-year mortality in BAV group.More studies, specifically randomized trials, are still warranted to further assess efficacy, safety and reassure the long-term outcomes in this group of patients.

Predictors of conduction disturbances after transcatheter aortic valve implantation with balloon-expandable valve for bicuspid aortic valve stenosis.

Implantation depth and membranous septum (MS) length have been established as the predictors of new-onset conduction disturbance (CD) after transcatheter aortic valve replacement (TAVR) for tricuspid aortic valve (TAV) stenosis. However, little is known about the predictors with bicuspid aortic valve (BAV). This study investigated the role of MS length and implantation depth in predicting CD following TAVR with a balloon-expandable valve in patients with BAV. This retrospective study analyzed 169 patients who underwent TAVR for BAV with balloon-expandable valve, and TAV cohort was established as a control group using propensity score (PS) matching. The primary endpoints were in-hospital new permanent pacemaker implantation (PPI) and new-onset CD (the composite outcome of new-onset left bundle branch block and new PPI). PPI developed in 14 patients (8.3%) and new-onset CD in 37 patients (21.9%) in theBAV cohort. Multivariate analysis revealed severe left ventricle outflow tract(LVOT) calcification (odds ratio [OR]: 5.83, 95% confidence interval [CI]: 1.08-31.5, p = .0407) and implantation depth-MS length (OR: 1.30, 95% CI: 1.12-1.51, p = .0005) as the predictors of new-onset CD within the BAV cohort. The matched comparison between BAV and TAV groups showed similar MS length (3.0 vs. 3.2 mm, p = .5307), but valves were implanted more deeply in the BAV group than in the TAV group (3.9 vs. 3.0 mm, p < .0001). New-onset CD was more frequent in patients who had BAV (22.3% vs. 13.9%, p = .0458). The implantation depth-MS length, and severe LVOT calcification predicted new-onset CD following TAVR in BAV with balloon-expandable valve. Among BAV patients, valves were implanted more deeply compared to TAV patients. High deployment technique could be considered to avoid new-onset CD in BAV anatomy.

Risk of Coronary Obstruction During Redo-TAVR in Patients With Bicuspid Versus Tricuspid Aortic Valve Stenosis

The aim of this study was to investigate the risk of coronary obstruction during redo-transcatheter aortic valve replacement (TAVR) within a previously implanted self-expanding valve in bicuspid aortic valve (BAV) versus tricuspid aortic valve (TAV) stenosis. The prevalence of BAV in TAVR patients is expected to increase as the indication expands; however, no study has investigated the risk of coronary obstruction for future redo-TAVR in these patients. Computed tomography (CT) simulation analysis was performed in 86 type 0 BAV, 70 type 1 BAV, and 132 TAV patients who underwent TAVR with 1 VenusA-Valve (Venus Medtech) between January 2014 and December2019. CT-identified risk of coronary obstruction during redo-TAVR was observed in 36.1% of patients for the left coronary ostium (LCO) and 27.8% of patients for the right coronary ostium (RCO); however, the incidences were significantly lower in the type 0 BAV group than in the type 1 BAV or TAV group (for LCO: OR: 1.00 [reference] vs OR: 2.49; 95%CI: 1.24-5.01 vs OR: 2.60; 95%CI: 1.40-4.81; for RCO: OR: 1.00 [reference] vs OR: 2.14; 95%CI: 1.02-4.48 vs OR: 1.97; 95%CI: 1.02-3.80). The leaflet laceration technique may be unfeasible to improve coronary flow in 61.5% of the threatened LCOs and 58.8% of the threatened RCOs during redo-TAVR. The percentages were significantly or numerically lower in the type 0 BAV group than other groups (for LCO: 26.3% vs 62.1% vs 73.2%; P overall=0.001; for RCO: 43.8% vs 65.2% vs 61.0%; P overall=0.374). Differences in anatomical features may impact the feasibility of future redo-TAVR. Type 0 BAV anatomy was associated with the lower incidence of CT-identified risk of coronary obstruction during redo-TAVR, and the leaflet laceration technique may be more feasible to ensure coronary flow in this population.

Abstract 13938: Multi-Chamber Strain Characterization Provides Incremental Prognostic Value to Cardiac Damage Staging in Significant Aortic Stenosis

Introduction: The survival impact of impaired multi-chamber longitudinal strain in significant tricuspid aortic valve stenosis(TAV-AS) and its relation to cardiac damage staging(CDS) is unknown. Hypothesis: Impaired strain improves prognostication of CDS in significant TAV-AS. Methods: We performed 2D-semi-automated strain analysis in a retrospective cohort of consecutive patients with TAV-AS with mean pressure gradient≥30mmHg on echocardiogram. The outcome was all-cause death. Cutoffs of impaired left-ventricular global longitudinal strain(

Evaluation of Post-Stenotic Aortic Dilatation in Patients with Structurally Normal (Tricuspid) Aortic Valve Stenosis

Evaluation of Post-Stenotic Aortic Dilatation in Patients with Structurally Normal (Tricuspid) Aortic Valve Stenosis

TCT-57 Updated Clinical and Procedural Outcomes in TAVR for Bicuspid Versus Tricuspid Aortic Valve Stenosis

TCT-57 Updated Clinical and Procedural Outcomes in TAVR for Bicuspid Versus Tricuspid Aortic Valve Stenosis

Transcatheter aortic valve implantation outcomes compared between bicuspid aortic and tricuspid aortic valve stenosis: an updated systematic review and meta-analysis

Abstract Background TAVI has emerged as an attractive treatment modality based on promising recent trial data. Patients with BAV, a commonly encountered clinical condition have largely been excluded from a majority of trials. Purpose Elderly patients with BAV and severe AS are increasingly encountered in clinical practice. This meta-analysis compares clinical outcomes between bicuspid and tricuspid AV patients to address the current knowledge-gap and identify optimal management strategies of these patients. Methods A comprehensive literature search was performed in PubMed, Embase, and Cochrane to identify the available observational studies comparing outcomes of TAVI in BAV and TAV patients. Summary effects were calculated using a DerSimonian and Laird random-effects model as odds ratio with 95% confidence intervals for all the clinical endpoints. Results 16 Observational studies met inclusion criteria, comprising 10,053 patients with BAV and 173,307 patients with TAV that underwent TAVI. No significant differences in 30-day and long-term mortality rates were observed. Patients with BAV had an increased risk of stroke (OR 1.23; 95% CI [1.06–1.44], p=0.007), re-intervention (OR 1.90; 95% CI [1.15–3.15], p=0.01), paravalvular leak (OR 1.42; 95% CI [1.25–1.61], p&amp;lt;0.ehab724.22251), conversion to open surgery (OR 1.93; 95% CI [1.21–3.07], p=0.006), and new pacemaker implantation (1.57; 95% CI (1.06 - 2.33, p=0.02). Adverse event rates are lower with the use of newer generation of valves. No significant difference in major vascular complications, major bleeding, or incidence of AKI was noted. Conclusions Complication rates for BAV TAVI are higher, but mortality is similar to TAV TAVI indicating TAVI is an appropriate alternative for intermediate-high risk patients with BAV. A better understanding of valve anatomy, physician expertise, the use of newer-generation valves can help reduce these complications. Funding Acknowledgement Type of funding sources: None.

Bicuspid aortic valve is associated with less coronary artery calcium and coronary artery disease burden by computed tomography

Abstract Background Bicuspid aortic valve (BAV) is associated with genetic defects (NOTCH 1, GATA 5 mutations) and aortopathy. Differences in flow pattern and a genetic predisposition could also affect coronary arteries. Purpose To assess the coronary artery calcium score (CACS) and coronary artery disease (CAD) burden by coronary computed tomography angiography (CTA) in patients with BAV stenosis, as compared to those with tricuspid aortic valve (TAV) stenosis. Methods 47 patients with congenital BAV (68.9 years±12.9, 38.3% females) who underwent cardiovascular CTA for TAVR planning were matched with 47 TAV patients for age, gender, smoking, arterial hypertension, dyslipidemia, diabetes, body-mass-index and chronic kidney disease. The coronary artery calcium score (CACS) (Agatston Units=AU) and coronary stenosis severity by CTA (CADRAD:&amp;lt;25% minimal,&amp;lt;50%milde,50–70%moderate,&amp;gt;70/%severe) were quantified. Results The coronary artery calcium score (CACS) was lower in BAV (237.4 vs. 1013.3AU; p&amp;lt;0.001), and coronary stenosis severity was less (CAD-RAD:p&amp;lt;0.001) as compared to patients with TAV. More patients with BAV had CACS zero (27.7% vs. 0%, p&amp;lt;0.001). The majority (68.1%) of patients with BAV had no or non-obstructive CAD but only 25.5% of tricuspid (p&amp;lt;0.001). Obstructive CAD (&amp;gt;50% stenosis) by CTA was more frequently observed in TAV patients (68.1%; p&amp;lt;0.001). There were no differences in statin use and NOAC, and other co-morbidities such as AF and COPD. Conclusion Patients with BAV have markedly less coronary artery calcium load and yielded less severe coronary stenosis. CTA succeeds to rule out obstructive CAD in the majority of patients with BAV, with adherent implications for TAVR planning. Funding Acknowledgement Type of funding sources: None. 72 YOM with BAV, zero CACS and no CADCACS was lower in BAV

Prospective evaluation of commissural alignment of balloon-expandable transcatheter heart valves utilizing pre- and post-procedure computed-tomogrpahy

Abstract Background Previous studies suggested that bioprosthetic valve commissural alignment may improve device performance and clinical outcomes in patients undergoing transcatheter aortic valve implantation (TAVI). However, no cath-lab method for correct commissural alignment of balloon-expandable valves was described to-date. Our aim is to evaluate the impact of a predefined patient specific crimped SAPIEN 3 orientation on its final implant orientation in relation to original valve commissures and overlap with coronary arteries as demonstrated by cardiac computed tomography (CT) in tricuspid aortic valve stenosis patients. Methods and results A prospective study of patients undergoing TAVI with SAPIEN 3 (Edwards Lifesciences), including post procedure cardiac CT. Patients were divided to 2 groups, a planned group in which the SAPIEN 3 was crimped before implantation in a pre-defined position, and a control group with conventional valve deployment. All patients underwent pre and post TAVI cardiac CT, which were evaluated by cardiac imaging experts that were blinded to the method of valve deployment. Twenty-eight patients were prospectively evaluated before and after TAVI with SAPIEN 3. All patients had elevated risk for open-heart surgery (age 77.6±7.9 years, 68% male, STS PROM 4.4%±3.4%). Fifteen patients were included in the active alignment group vs. thirteen patients in the control. Patients in the active alignment group had a trend for more correct commissural alignment (73.3% vs. 38.5%, p=0.06). There was no statistically significant difference in patient characteristics, echocardiographic measures or in anatomical CT features between the active commissural alignment and control groups. Conclusion This is probably the first study that shows that patient-specific initial crimped orientation of balloon-expandable TAVI may improve our ability to have correct commissural alignment of the implanted valve. Our prospective study continues to recruit patients and updated study results will be presented. Funding Acknowledgement Type of funding sources: None.

Outcomes After Transcatheter Aortic Valve Replacement in Bicuspid Versus Tricuspid Anatomy: A Systematic Review and Meta-Analysis.

The aim of this study was to compare the feasibility, safety, and clinical outcomes of transcatheter aortic valve replacement (TAVR) in bicuspid aortic valve (BAV) versus tricuspid aortic valve (TAV) stenosis. At present, limited observational data exist supporting TAVR in the context of bicuspid anatomy. Primary endpoints were 1-year survival and device success. Secondary endpoints included moderate to severe paravalvular leak (PVL) and a composite endpoint of periprocedural complications; incidence rates of individual procedural endpoints were also explored individually. In the main analysis, 17 studies and 181,433 patients undergoing TAVR were included, of whom 6,669 (0.27%) had BAV. A secondary analysis of 7,071 matched subjects with similar baseline characteristics was also performed. Device success and 1-year survival rates were similar between subjects with BAV and those with TAV (97% vs 94% [P=0.55] and 91.3% vs 90.8% [P=0.22], respectively). In patients with BAV, a trend toward a higher risk for periprocedural complications was observed in our main analysis (risk ratio [RR]: 1.12; 95% CI: 0.99-1.27; P=0.07) but not in the matched population secondary analysis (RR: 1.00; 95%CI: 0.81-1.24; P=0.99). The risk for moderate to severe PVL was higher in subjects with BAV (RR: 1.42; 95%CI: 1.29-1.58; P< 0.0001) as well as the incidence of cerebral ischemic events (2.4% vs 1.6%; P=0.015) and of annular rupture (0.3% vs 0.02%; P=0.014) in matched subjects. TAVR is a feasible option among selected patients with BAV anatomy, but the higher rates of moderate to severe PVL, annular rupture, and cerebral ischemic events observed in the BAV group warrant caution and further evidence.

Risk Factors of Midterm Mortality After Aortic Valve Replacement for Severe Calcified Tricuspid Aortic Valve Stenosis: A retrospective analysis of Perioperative Events Assessment in Adult Cardiac surgery (PESSAC) Registry

The European System for Cardiac Operative Risk Evaluation II (EuroSCORE II) initially developed for predicting early postoperative mortality ofall typesof cardiac surgery, is less able to predict, more specifically, long-term outcomes after aortic valve replacement (AVR). The study authors here evaluated the risk factors for three-year mortality after isolated aortic valve replacement (AVR) for severe calcified tricuspid aortic valve stenosis and compared them with EuroSCORE II to predict long-term outcomes. A retrospective study. A university teaching hospital. This study included 1,101 adults who underwent isolated AVR for severe calcified tricuspid aortic valve stenosis between September 2010 to June 2015. None. The primary endpoint was that of three-year all-cause mortality after AVR. By three years, 168 patients (15.3%) had died. Risk factors for all-cause mortality were: male gender (odds ratio [OR]=1.78; 95% confidence interval [CI]=1.21-2.62; p < 0.01), peripheral arterial disease (OR=1.77; 95% CI=1.08-2.92; p=0.03), age (OR=1.06 per year increase; 95% CI =1.04-1.09; p < 0.01), pulmonary artery systolic pressure (OR=1.02 per mmHg increase; 95% CI=1.01-1.03; p < 0.01), platelet count (OR=1.003 per G/L increase; 95% CI=1.000-1.005; p=0.04), and valve area (OR=0.97 per cm²/m² increase; 95% CI= 0.95-0.99; p < 0.01). The area under the receiver operating characteristic curves were 0.67 (95% CI=0.60-0.75) and 0.60 (95% CI=0.56-0.65) for the authors' logistic regression model and EuroSCORE II, respectively (p=0.11). The study authors identified six independent risk factors for three-year mortality after isolated AVR. The logistic regression model had relatively modest predictive performance for three-year mortality.

Non-aneurysmal ascending aorta diameter changes after aortic valve replacement in patients with stenotic bicuspid and tricuspid aortic valve.

The appropriate timing of aortic repair in patients with bicuspid aortic valve-related aortopathy remains controversial. We describe the changes in diameter of the non-aneurysmal ascending aorta after aortic valve replacement for bicuspid or tricuspid aortic valve stenosis. This retrospective review included 189 patients who had undergone aortic valve replacement for severe stenotic aortic valve with a non-aneurysmal ascending aorta diameter of 45mm or less between January 2008 and December 2018. A linear mixed-effect model was used to analyze and compare the enlargement rates of the non-aneurysmal ascending aorta at the tubular portion after aortic valve replacement in bicuspid and tricuspid aortic valve patients. The enlargement rate of the non-aneurysmal ascending aorta after aortic valve replacement was significantly greater in the bicuspid aortic valve group than in the tricuspid aortic valve group (0.36mm/year vs. 0.09mm/year, p < 0.001). The specific form of bicuspid aortic valve also affected aorta diameter enlargement: the enlargement rate of 0.85mm/year in the Type 0 (according to Sievers' classification) group was approximately five times that in the Non-Type 0 group (p < 0.001). No aortic events were observed, and no patients needed reoperations for the ascending aorta, in either the bicuspid or tricuspid aortic valve groups. The persistent possibility of progressive ascending aortic dilatation after aortic valve replacement for bicuspid aortic valve stenosis, especially in Type 0 bicuspid aortic valve patients, demands careful post-procedural evaluation of the ascending aorta.

Predictors of calcification distribution in severe tricuspid aortic valve stenosis

We investigated aortic valve calcification (AVC) distribution and predictors for leaflet calcification patterns in patients with severe tricuspid aortic valve stenosis undergoing transcatheter aortic valve replacement (TAVR). Patients undergoing routine multi-sliced computed tomography (MSCT) for procedural planning were enrolled. MSCT data were transferred to a dedicated workstation for evaluation (3mensio Structural Heart™, Pie Medical Imaging BV, Maastricht, The Netherlands) and analyzed. Participants were separated into asymmetrical (AC) and symmetrical (SC) leaflet calcification and potential predictors for calcification distribution were identified with univariate and multivariate regression analysis. 567 Participants with severe tricuspid AS were divided into asymmetrical (AC, n = 443; 78.1%) and symmetrical (SC, n = 124; 21.9%) AVC. In AC, the non-coronary cusp was the most calcified cusp (n = 238; 57.7%). SC is more common in females (AC/SC: 49.2% vs. 67.7%; p < 0.0001). AVC was more severe in patients with AC, who also have larger aortic root dimensions. Multivariate analysis depicted, inter alia, left ventricular outflow tract (LVOT) calcification < 25 Agatston units (OR 1.81 [1.09–3.00], p = 0.021), a mean pressure gradient < 36 mmHg (OR 1.77 [1.03–3.05], p = 0.039), and an annulo-apical angle > 67° (OR 1.68 [1.00–2.80], p = 0.049) as predictors for SC, although with only moderate predictive value. Data from this retrospective analysis indicate that SC occurs more frequently in females. The cumulative leaflet calcification burden is higher in patients with AC, who also present with larger aortic root dimensions. The predictive value for prominent calcification of different aortic valve cusps in AC patients was only low to moderate.Trial registration number: NCT01805739.

Heritability of aortic valve stenosis and evidence of bicuspid enrichment in families with tricuspid aortic valve stenosis

Abstract Background Calcific aortic valve stenosis (CAVS) is the most common valvular heart disease. Although a familial component has been described, the heritability remains unknown. This study aimed to determine the heritability of CAVS and to compare the prevalence of bicuspid aortic valve (BAV) relatives among families with tricuspid and bicuspid aortic valve phenotype and to a control cohort. Methods Probands were recruited following aortic valve replacement in three French university hospitals. All relatives who agreed to participate were enrolled in the study. Families were defined as tricuspid aortic valve (TAV) or BAV families based on the aortic valve phenotype observed in the proband. As control group, we used probands diagnosed with mitral valve prolapse and their families. All recruited probands and relatives underwent comprehensive transthoracic echocardiography to determine aortic valve morphology and CAVS status. Additive genetic heritability was performed with SOLAR genetic statistics package. Prevalence of BAV relatives in each sub-group and Prevalence Ratio were calculated. Results Within the 2371 relatives coming from 138 CAVS families, the heritability of CAVS was significant (h2=0.49, p&amp;lt;0.001). Furthermore, TAV stenosis heritability was only significant in TAV families (h2=0.20, p=0.013). The prevalence of BAV was significantly higher in TAV families and BAV families than control families (5.96 [95% CI: 4.2–8.3%], [n=32 of 537] vs. 2.49 [95% CI: 1.3–4.7%], [n=9 of 361]; PR 2.64 [95% CI: 1.41–5.91]; p=0.005 and 10.20 [95% CI: 7.0–14.5%], [n=26 of 255] vs. 2.49 [95% CI: 1.3–4.7%], [n=9 of 361]; PR 4.63 [95% CI: 2.35–13.44]; p&amp;lt;0.001; respectively). Conclusions The heritability of aortic valve stenosis in this population confirms the genetic effect in determining aortic stenosis for all aortic valve phenotype and for tricuspid aortic valve. The bicuspid enrichment in TAV families suggests common genetic predisposition of aortic valve stenosis in some families. Taking all together, these findings encourage echocardiography screening of relatives of affected individuals. Funding Acknowledgement Type of funding source: None

Characteristics of aortic root and vascular anatomy in bicuspid versus tricuspid aortic valve stenosis in patients undergoing transcatheter aortic valve implantation

Abstract Background Transcatheter aortic valve implantation (TAVI) is being increasingly performed in patients with bicuspid aortic valve stenosis (AS). Objectives This study sought to compare aortic root and ilio-femoral artery characteristics and clinical outcomes in patients with bicuspid versus tricuspid AS from the Bicuspid AS TAVI multicenter registry. Methods 88 patients with bicuspid AS and 213 matched patients with tricuspid AS were referred for pre-procedural computed tomography (CT) evaluation before TAVI. We performed a detailed assessment of aortic root anatomy: size of the annulus, sinus of Valsalva (SoV), sino-tubular junction (STJ); we also determined the dimensions of aorta, left subclavian, and ilio-femoral arteries. Results Patients with bicuspid AS had significantly larger aortic root dimensions, (annulus mean diameter: 25.5±2.9 mm vs. 23.7±2.4 mm, SoV mean diameter: 35.3±4.7 mm vs. 32±4.4mm, STJ mean diameter: 31.5±4.9 mm vs. 27.6±3.5 mm; respectively) than patients with tricuspid AS (P value for all &amp;lt;0.001), even after adjustment for their larger BSA and height. Dimensions of ascending aorta, left subclavian artery, and ilio-femoral arteries were also consistently larger in bicuspid than in tricuspid AS morphology. Conclusions Patients with bicuspid AS had significantly larger aortic root dimensions, larger ascending aorta, subclavian artery and ilio-femoral arteries even after adjustment for their BSA and height. Funding Acknowledgement Type of funding source: Public hospital(s). Main funding source(s): Rabin Medical Center

Midterm outcome comparison between patients with bicuspid or tricuspid aortic stenosis undergoing transcatheter aortic valve replacement

Objective: To compare the prognosis of transcatheter aortic valve replacement (TAVR) in patients with bicuspid aortic valve (BAV) or tricuspid aortic valve (TAV) stenosis. Methods: This was a retrospective study. Patients with symptomatic severe aortic stenosis, who underwent TAVR with follow-up time more than one year in Guangdong Provincial People's Hospital from April 2016 to August 2018, were included. According to aortic CT angiography, the patients were divided into BAV group and TAV group. The primary endpoint was the composite event of all-cause death and stroke, and the secondary endpoints were TAVR-related complications. Incidence of clinical endpoints and parameters derived from echocardiography were compared between the groups, and Kaplan-Meier survival analysis was used to compare the composite event between the two groups. Results: A total of 49 patients were included. The age was (73.6±6.3) years, and 25(51.0%) were male. There were 32 patients in BAV group and 17 in TAV group, the follow-up time was 466 (390, 664) days. The incidence of composite endpoint of death and stroke at one year were comparable in BAV and TAV groups (6.3% (2/32) vs. 5.9% (1/17), P=1.00). Kaplan-Meier curves also showed a similar risk of the composite endpoint(HR=1.03，95%CI 0.09-11.24，Log-rank P=0.98) between two groups. The incidence of all-cause death, stroke, myocardial infarction, severe bleeding, major vascular complications, new-onset atrial fibrillation or atrial flutter, and permanent pacemaker implantation were all similar between the two groups(all P>0.05), and there was no acute kidney injury (stage 2 or 3) in both groups. Echocardiographic parameters at one year were similar between the two groups (all P>0.05). Conclusions: The midterm prognosis of TAVR in patients with BAV and TAV stenosis is similar. Clinical trials of large sample size with long-term follow-up are warranted to verify our findings.