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Predictors of high residual gradient after transcatheter aortic valve replacement in bicuspid aortic valve stenosis.

Clinical research in cardiology : official journal of the German Cardiac Society

Authors: Giulia Bugani, Matteo Pagnesi, Didier Tchetchè, Won- Keun Kim, Arif Khokhar, Jean- Malte Sinning, Uri Landes, Ran Kornowski, Pablo Codner, Ole De Backer, Georg Nickenig, Alfonso Ielasi, Chiara De Biase, Lars Søndergaard, Federico De Marco, Marco Ancona, Matteo Montorfano, Damiano Regazzoli, Giulio Stefanini, Stefan Toggweiler, Corrado Tamburino, Sebastiano Immè, Giuseppe Tarantini, Horst Sievert, Ulrich Schäfer, Jörg Kempfert, Jochen Wöehrle, Maurizio Tespili, Alessandra Laricchia, Azeem Latib, Francesco Giannini, Antonio Colombo, Antonio Mangieri

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.

PMID: 33389062

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