TAVR for Bicuspid Vs. Tricuspid Aortic Valve Stenosis

MedicalResearch.com Interview with:
Sung-Han Yoon MD
Clinical Trials, Cardiology, Developmental Biology
Cedars-Sinai Medical Center, Los Angeles

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Transcatheter aortic valve replacement (TAVR) has become the standard treatment in inoperable patients in high surgical risk patients with symptomatic severe aortic stenosis (AS). However, major randomized trials excluded congenital bicuspid AS due to its unique morphological features. The indication of TAVR is expanding into a younger population, in which the frequency of bicuspid AS is higher. Therefore, we will encounter TAVR for bicuspid AS more frequently. However, the experience of TAVR in bicuspid AS is limited to small series. Therefore, we aim to evaluate the clinical outcomes of TAVR in bicuspid AS and compare them to tricuspid AS.

MedicalResearch.com: What are the main findings?

Response: Within the group receiving the early generation devices (SapienXT/CoreValve), bicuspid AS had more frequent conversion to surgery and significantly lower device success rate compared to tricuspid AS. Among patients receiving the new generation devices (Sapien3/Lotus/Evolut R), however, procedural outcomes were similar between bicuspid and tricuspid AS. The cumulative all-cause mortality rates at 2-year were comparable between bicuspid and tricuspid aortic stenosis.

MedicalResearch.com: What should readers take away from your report?

Response: Compared to tricuspid AS, TAVR in bicuspid AS was associated with similar prognosis although lower device success rate. Procedural challenges were observed in patients treated with the early generation devices whereas no differences were observed with the new generation devices.

MedicalResearch.com: What recommendations do you have for future research as a result of this study?

Response: Larger studies are warranted to evaluate the influence of bicuspid AS phenotype on TAVR outcomes. In addition, future studies are needed to evaluate long-term outcomes and valve durability after TAVR in patients with bicuspid AS.

No conflicts of interest to declare

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Citation: JACC
Procedural and Clinical Outcomes in Transcatheter Aortic Valve Replacement for Bicuspid Versus Tricuspid Aortic Valve Stenosis
Sung-Han Yoon, Sabine Bleiziffer, Ole De Backer, Victoria Delgado, Takahide Arai, Johannes Ziegelmueller, MarcoBarbanti, Rahul Sharma, Gidon Y. Perlman, Omar K. Khalique, Erik W. Holy, Smriti Saraf, Florian Deuschl, Buntaro Fujita, Philipp Ruile, Franz-Josef Neumann, Gregor Pache, Masao Takahashi, Hidehiro Kaneko, Tobias Schmidt, Yohei Ohno, Niklas Schofer, William K.F. Kong, Edgar Tay, Daisuke Sugiyama, Hiroyuki Kawamori, Yoshio Maeno, Yigal Abramowitz, Tarun Chakravarty, Mamoo Nakamura, Shingo Kuwata, Gerald Yong, Hsien-Li Kao, Michael Lee, Hyo-Soo Kim, ThomasModine, S. Chiu Wong, Francesco Bedgoni, Luca Testa, Emmanuel Teiger, Christian Butter, Stephan M. Ensminger, Ulrich Schaefer, Danny Dvir, Philipp Blanke, Jonathon Leipsic, Fabian Nietlispach, Mohamed Abdel-Wahab, BernardChevalier, Corrado Tamburino, David Hildick-Smith, Brian K. Whisenant, Seung-Jung Park, Antonio Colombo, AzeemLatib, Susheel K. Kodali, Jeroen J. Bax, Lars Søndergaard, John G. Webb, Thierry Lefèvre, Martin B. Leon, Raj Makkar
DOI: 10.1016/j.jacc.2017.03.017

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Last Updated on March 19, 2017 by Marie Benz MD FAAD