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Balloon-Expandable Valve Geometry After Transcatheter Aortic Valve Replacement in Low-Risk Patients With Bicuspid Versus Tricuspid Aortic Stenosis. 2021
Giorgio A Medranda, and
Toby Rogers, and
Brian J Forrestal, and
Brian C Case, and
Charan Yerasi, and
Chava Chezar-Azerrad, and
Christian C Shults, and
Rebecca Torguson, and
Corey Shea, and
Puja Parikh, and
Thomas Bilfinger, and
Thomas Cocke, and
Mariano E Brizzio, and
Robert Levitt, and
Chiwon Hahn, and
Nicholas Hanna, and
George Comas, and
Paul Mahoney, and
Joseph Newton, and
Maurice Buchbinder, and
Cheng Zhang, and
Paige E Craig, and
W Guy Weigold, and
Federico M Asch, and
Gaby Weissman, and
Hector M Garcia-Garcia, and
Itsik Ben-Dor, and
Lowell F Satler, and
Ron Waksman
Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, United States of America.
Prospective bicuspid low-risk transcatheter aortic valve replacement (TAVR) registries' data demonstrated encouraging short-term results. Detailed data on transcatheter heart valve (THV) geometry after deployment using contemporary devices are lacking. This study sought to examine valve geometry after TAVR in patients with bicuspid aortic stenosis (AS). The study population was patients from the LRT (Low Risk TAVR) trial who underwent TAVR using the SAPIEN 3 THV for bicuspid and tricuspid AS. THV geometry measured on 30-day computed tomography (CT) included valve height, angle, depth, and eccentricity. Additionally, THV hemodynamics and outcomes post-TAVR were compared among patients with bicuspid and tricuspid AS. A total of 107 patients from the LRT trial using the SAPIEN 3 THV were included in our analysis. On 30-day CT, the valve height ratio (1.07 vs. 1.07; p = 0.348), depths (right [5.6 mm vs. 6.2 mm; p = 0.223], left [5.3 mm vs. 4.4 mm; p = 0.082] and non [4.8 mm vs. 4.5 mm; p = 0.589] coronary cusps), eccentricities (1.08 vs. 1.07; p = 0.9550), and angles (except the right [3.9 degrees vs. 6.3 degrees; p = 0.003] and left [3.6 degrees vs. 6.0 degrees; p = 0.007]) were similar between bicuspid and tricuspid patients. Hemodynamics, stroke, and mortality were similar at 1 year. Despite challenging bicuspid anatomy of the aortic valve, our comprehensive CT analysis supports similar THV geometry between patients with bicuspid and tricuspid AS undergoing TAVR using the SAPIEN 3 THV in low-risk patients. This translated to excellent short-term clinical outcomes and THV hemodynamics in both aortic valve morphologies. NCT02628899, https://clinicaltrials.gov/ct2/show/NCT02628899.
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