Abstract
Objectives
To define the incidence of high residual gradient (HRG) after transcatheter aortic valve replacement (TAVR) in BAVs and their impact on short term outcome and 1-year mortality.
Background
Transcatheter heart valves (THVs) offer good performance in tricuspid aortic valves with low rate of HRG. However, data regarding their performance in bicuspid aortic valves (BAV) are still lacking.
Methods
The BEAT (Balloon vs Self-Expandable valve for the treatment of bicuspid Aortic valve sTenosis) registry included 353 consecutive patients who underwent TAVR (Evolut R/PRO or Sapien 3 valves) in BAV between June 2013 and October 2018. The primary endpoint was device unsuccess with post-procedural HRG (mean gradient ≥ 20 mmHg). The secondary endpoint was to identify the predictors of HRG following the procedure.
Results
Twenty patients (5.6%) showed HRG after TAVR. Patients with HRG presented higher body mass index (BMI) (30.7 ± 9.3 vs. 25.9 ± 4.8; p < 0.0001) and higher baseline aortic mean gradients (57.6 ± 13.4 mmHg vs. 47.7 ± 16.6, p = 0.013) and more often presented with BAV of Sievers type 0 than patients without HRG. At multivariate analysis, BMI [odds ratio (OR) 1.12; 95% confidence interval (CI) 1.05–1.20, p = 0.001] and BAV type 0 (OR 11.31, 95% CI 3.45–37.06, p < 0.0001) were confirmed as independent predictors of high gradient.
Conclusion
HRG following TAVR in BAVs is not negligible and is higher among patients with high BMI and with BAV 0 anatomy.
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Change history
23 March 2021
A Correction to this paper has been published: https://doi.org/10.1007/s00392-021-01824-z
Abbreviations
- HRG:
-
High residual gradient
- THV:
-
Transcatheter heart valve
- TAVI:
-
Transcatheter aortic valve implantation
- TAVR:
-
Transcatheter aortic valve replacement
- BAV:
-
Bicuspid aortic valves
- VARC:
-
Valve Academic Research Consortium
- BMI:
-
Body mass index
- OR:
-
Odds ratio
- CI:
-
Confidence interval
- PAR:
-
Paravalvular aortic regurgitation
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This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
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The authors declare that they have no conflict of interest.
Ethical approval
This is an observational study and was conducted from data obtained for clinical purposes. The BEAT (Balloon vs Self-Expandable valve for the treatment of bicuspid Aortic valve sTenosis) registry has been approved by local Ethical Committee.
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Informed consent was obtained from all individual participants included in the study.
Additional information
The original online version of this article was revised: The original version of this article, published on January 3, 2021, contained a mistake. The spelling of Arif Khokhar’s name was incorrect. The original article has been corrected.
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Bugani, G., Pagnesi, M., Tchetchè, D. et al. Predictors of high residual gradient after transcatheter aortic valve replacement in bicuspid aortic valve stenosis. Clin Res Cardiol 110, 667–675 (2021). https://doi.org/10.1007/s00392-020-01793-9
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DOI: https://doi.org/10.1007/s00392-020-01793-9