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

Clin Res Cardiol. 2021 May;110(5):667-675. doi: 10.1007/s00392-020-01793-9. Epub 2021 Jan 3.

Abstract

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.

Keywords: Balloon-expandable valve; Bicuspid; High residual gradient; Self-expandable valve; Transcatheter aortic valve implantation.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Aortic Valve Stenosis / pathology
  • Aortic Valve Stenosis / surgery*
  • Bicuspid Aortic Valve Disease / pathology
  • Bicuspid Aortic Valve Disease / surgery*
  • Female
  • Follow-Up Studies
  • Humans
  • Incidence
  • Male
  • Mortality
  • Registries
  • Transcatheter Aortic Valve Replacement / methods*
  • Treatment Outcome