Transcatheter Aortic Valve Replacement in Patients with Aortic Stenosis Having Coronary Cusp Fusion versus Mixed Cusp Fusion Nonraphe Bicuspid Aortic Valve

Wen-Hua Lei, Yan-Biao Liao, Zi-Jie Wang, Yuan-Weixiang Ou, Jiay-Yu Tsauo, Yi-Jian Li, Tian-Yuan Xiong, Zhen-Gang Zhao, Xin Wei, Wei Meng, Yuan Feng, Mao Chen, Wen-Hua Lei, Yan-Biao Liao, Zi-Jie Wang, Yuan-Weixiang Ou, Jiay-Yu Tsauo, Yi-Jian Li, Tian-Yuan Xiong, Zhen-Gang Zhao, Xin Wei, Wei Meng, Yuan Feng, Mao Chen

Abstract

Objectives: We aimed to assess the procedural and clinical results of transcatheter aortic valve replacement (TAVR) for nonraphe bicuspid aortic stenosis (AS) with coronary vs mixed cusp fusion.

Background: It remains unclear whether cusp fusion morphology affects TAVR outcomes in patients with nonraphe bicuspid AS.

Methods: This retrospective study enrolled consecutive patients with severe symptomatic AS and type-0 bicuspid aortic valve, who underwent TAVR at our institution between 2012 and 2017. TAVR outcomes were defined based on the Valve Academic Research Consortium-2 recommendations.

Results: Compared to patients with mixed cusp fusion (44/71), those with coronary cusp fusion (27/71) had a larger ellipticity index for the aortic annulus (21.9% ± 9.0% vs 15.6% ± 9.3%, p=0.007) and increased left ventricular outflow tract obstruction (31.1% ± 9.4% vs 26.9% ± 7.5%, p=0.04) but comparable rates of second valve implantation (15.9% vs 14.8%), mild paravalvular leakage (PVL, 38.5% vs 30.2%), permanent pacemaker implantation (PPM, 25.9% vs 15.9%), and 30-day mortality (7.4% vs 6.8%). Use of a first-generation transcatheter heart valve was associated with higher risk for mild PVL (odds ratio (OR) = 4.37; 95% confidence interval (95% CI) = 1.14-16.75; p=0.03) but not PPM (OR = 0.77; 95% CI = 0.22-2.62; p=0.67), whereas a larger oversizing ratio tended to be associated with a higher PPM rate (OR = 1.49; 95% CI = 0.46-4.86; p=0.51) but lower incidence of mild PVL (OR = 0.51; 95% CI = 0.19-1.35; p=0.17).

Conclusions: In AS patients with type-0 bicuspid valves, cusp fusion morphology does not affect the procedural or clinical results of TAVR. Use of second-generation transcatheter heart valves may provide more favorable results in such patients. This trial is registered with NCT01683474.

Conflict of interest statement

Yuan Feng and Mao Chen are consultants/proctors of Venus MedTech. Other authors declared no conflicts of interest.

Copyright © 2019 Wen-hua Lei et al.

Figures

Figure 1
Figure 1
Definition of cusp fusion in type-0 bicuspid aortic stenosis: coronary cusp fusion morphology (a, b); mixed cusp fusion morphology (c, d). LC, left coronary cusp; NC, noncoronary cusp; RC, right coronary cusp.

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