Feasibility and Outcomes of Transcatheter Aortic Valve Implantation in High-Risk Patients With Stenotic Bicuspid Aortic Valves

Little is known about transcatheter aortic valve implantation (TAVI) in patients with bicuspid aortic valve stenosis, which usually represents a contraindication. The aim of this study was to assess the feasibility and the results of TAVI in this patient subset. Of 316 high-risk patients with severe...

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Veröffentlicht in:The American journal of cardiology 2012-09, Vol.110 (6), p.877-883
Hauptverfasser: Himbert, Dominique, MD, Pontnau, Florence, MD, Messika-Zeitoun, David, MD, PhD, Descoutures, Fleur, MD, Détaint, Delphine, MD, Cueff, Caroline, MD, Sordi, Martina, MD, Laissy, Jean-Pierre, MD, PhD, Alkhoder, Soleiman, MD, Brochet, Eric, MD, Iung, Bernard, MD, Depoix, Jean-Pol, MD, Nataf, Patrick, MD, Vahanian, Alec, MD
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container_end_page 883
container_issue 6
container_start_page 877
container_title The American journal of cardiology
container_volume 110
creator Himbert, Dominique, MD
Pontnau, Florence, MD
Messika-Zeitoun, David, MD, PhD
Descoutures, Fleur, MD
Détaint, Delphine, MD
Cueff, Caroline, MD
Sordi, Martina, MD
Laissy, Jean-Pierre, MD, PhD
Alkhoder, Soleiman, MD
Brochet, Eric, MD
Iung, Bernard, MD
Depoix, Jean-Pol, MD
Nataf, Patrick, MD
Vahanian, Alec, MD
description Little is known about transcatheter aortic valve implantation (TAVI) in patients with bicuspid aortic valve stenosis, which usually represents a contraindication. The aim of this study was to assess the feasibility and the results of TAVI in this patient subset. Of 316 high-risk patients with severe aortic stenosis who underwent TAVI from January 2009 to January 2012, 15 (5%) had documented bicuspid aortic valves. They were treated using a transarterial approach, using the Medtronic CoreValve system. Patients were aged 80 ± 10 years, in New York Heart Association functional classes III and IV. The mean aortic valve area was 0.8 ± 0.3 cm2 , and the mean gradient was 60 ± 19 mm Hg. The mean calcium score, calculated using multislice computed tomography, was 4,553 ± 1,872 arbitrary units. The procedure was successful in all but 1 patient. Major adverse events, according to Valvular Academic Research Consortium definitions, were encountered in 1 patient (death). The mean postimplantation prosthetic gradient was 11 ± 4 mm Hg, and ≤1+ periprosthetic leaks were observed in all but 2 patients. The mean prosthetic ellipticity index was 0.7 ± 0.2 at the level of the native annulus and 0.8 ± 0.2 at the level of the prosthetic leaflets. After a mean follow-up period of 8 ± 7 months, 1 patient had died from aortic dissection; there were no additional adverse events. All but 2 hospital survivors were in New York Heart Association class I or II. In conclusion, the present series suggests that transarterial Medtronic CoreValve implantation is feasible in selected patients with bicuspid aortic valve and may lead to short-term hemodynamic and clinical improvement.
doi_str_mv 10.1016/j.amjcard.2012.04.064
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The aim of this study was to assess the feasibility and the results of TAVI in this patient subset. Of 316 high-risk patients with severe aortic stenosis who underwent TAVI from January 2009 to January 2012, 15 (5%) had documented bicuspid aortic valves. They were treated using a transarterial approach, using the Medtronic CoreValve system. Patients were aged 80 ± 10 years, in New York Heart Association functional classes III and IV. The mean aortic valve area was 0.8 ± 0.3 cm2 , and the mean gradient was 60 ± 19 mm Hg. The mean calcium score, calculated using multislice computed tomography, was 4,553 ± 1,872 arbitrary units. The procedure was successful in all but 1 patient. Major adverse events, according to Valvular Academic Research Consortium definitions, were encountered in 1 patient (death). The mean postimplantation prosthetic gradient was 11 ± 4 mm Hg, and ≤1+ periprosthetic leaks were observed in all but 2 patients. The mean prosthetic ellipticity index was 0.7 ± 0.2 at the level of the native annulus and 0.8 ± 0.2 at the level of the prosthetic leaflets. After a mean follow-up period of 8 ± 7 months, 1 patient had died from aortic dissection; there were no additional adverse events. All but 2 hospital survivors were in New York Heart Association class I or II. 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The mean prosthetic ellipticity index was 0.7 ± 0.2 at the level of the native annulus and 0.8 ± 0.2 at the level of the prosthetic leaflets. After a mean follow-up period of 8 ± 7 months, 1 patient had died from aortic dissection; there were no additional adverse events. All but 2 hospital survivors were in New York Heart Association class I or II. In conclusion, the present series suggests that transarterial Medtronic CoreValve implantation is feasible in selected patients with bicuspid aortic valve and may lead to short-term hemodynamic and clinical improvement.</abstract><cop>New York, NY</cop><pub>Elsevier Inc</pub><pmid>22677157</pmid><doi>10.1016/j.amjcard.2012.04.064</doi><tpages>7</tpages></addata></record>
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identifier ISSN: 0002-9149
ispartof The American journal of cardiology, 2012-09, Vol.110 (6), p.877-883
issn 0002-9149
1879-1913
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source MEDLINE; Elsevier ScienceDirect Journals
subjects Aged
Aged, 80 and over
Aortic Valve - pathology
Aortic Valve - surgery
Aortic Valve Stenosis - surgery
Biological and medical sciences
Cardiac Catheterization
Cardiology
Cardiology. Vascular system
Cardiovascular
Congenital heart diseases. Malformations of the aorta, pulmonary vessels and vena cava
Coronary vessels
Endocardial and cardiac valvular diseases
Feasibility Studies
Female
Heart
Heart Valve Prosthesis Implantation - methods
Humans
Male
Medical imaging
Medical sciences
Middle Aged
Mitral Valve - surgery
Multidetector Computed Tomography
Postoperative Complications
Prostheses
Risk Factors
Severity of Illness Index
Surgery
Tomography
Treatment Outcome
title Feasibility and Outcomes of Transcatheter Aortic Valve Implantation in High-Risk Patients With Stenotic Bicuspid Aortic Valves
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