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

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A Correction to this article was published on 23 March 2021

This article has been updated

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.

Graphic abstract

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Abbreviations

HRG:

High residual gradient

THV:

Transcatheter heart valve

TAVI:

Transcatheter aortic valve implantation

TAVR:

Transcatheter aortic valve replacement

BAV:

Bicuspid aortic valves

VARC:

Valve Academic Research Consortium

BMI:

Body mass index

OR:

Odds ratio

CI:

Confidence interval

PAR:

Paravalvular aortic regurgitation

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Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Author information

Authors and Affiliations

  1. Cardiology Unit, Azienda Ospedaliero Universitaria di Ferrara Arcispedale Sant’Anna, Ferrara, Italy

    Giulia Bugani

  2. San Raffaele Scientific Institute, Milan, Italy

    Matteo Pagnesi, Marco Ancona & Matteo Montorfano

  3. Groupe CardioVasculaire Interventionnel, Clinique Pasteur, Toulouse, France

    Didier Tchetchè & Chiara De Biase

  4. Department of Cardiology, Kerckhoff Heart Center, Bad Nauheim, Germany

    Won- Keun Kim

  5. Interventional Cardiology Unit, GVM Care and Research, Maria Cecilia Hospital, via della Corriera 1, 48033, Cotignola, Ravenna, Italy

    Arif Khokhar, Alessandra Laricchia, Francesco Giannini, Antonio Colombo & Antonio Mangieri

  6. Cardiology Department, University Hospital Bonn, Bonn, Germany

    Jean- Malte Sinning & Georg Nickenig

  7. Cardiology Department, Rabin Medical Center, Petah Tikva, Israel

    Uri Landes, Ran Kornowski & Pablo Codner

  8. The Heart Center-Rigshospitalet, Copenhagen, Denmark

    Ole De Backer & Lars Søndergaard

  9. Istituto Clinico Sant’Ambrogio, Milan, Italy

    Alfonso Ielasi & Maurizio Tespili

  10. Department of Cardiology, IRCCS Policlinico San Donato, Milan, Italy

    Federico De Marco

  11. Clinical and Interventional Cardiology Unit, Cardio Center, Humanitas Research Hospital, Rozzano, Milan, Italy

    Damiano Regazzoli & Giulio Stefanini

  12. Heart Center Lucerne, Luzerner Kantonsspital, Lucerne, Switzerland

    Stefan Toggweiler

  13. Cardiology Division, CAST Policlinico Hospital, University of Catania, Catania, Italy

    Corrado Tamburino

  14. Centro Cuore Morgagni, Catania, Italy

    Sebastiano Immè

  15. Interventional Cardiology Unit, University of Padova, Padua, Italy

    Giuseppe Tarantini

  16. Cardiovascular Center Frankfurt, Frankfurt, Germany

    Horst Sievert

  17. Anglia Ruskin University, Chelmsford, UK

    Horst Sievert

  18. UKE Hamburg, Hamburg, Germany

    Ulrich Schäfer

  19. Deutsches Herzzentrum Berlin, Charité Universitätsmedizin, Berlin, Germany

    Jörg Kempfert

  20. Ulm University, Ulm, Germany

    Jochen Wöehrle

  21. Department of Cardiology, Montefiore Medical Center, New York, NY, USA

    Azeem Latib

  22. Division of Cardiology, Department of Medicine, University of Cape Town, Cape Town, South Africa

    Azeem Latib

  23. EMO GVM Centro Cuore Columbus, Milan, Italy

    Antonio Colombo

Authors
  1. Giulia Bugani
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  2. Matteo Pagnesi
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  3. Didier Tchetchè
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  4. Won- Keun Kim
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  5. Arif Khokhar
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  6. Jean- Malte Sinning
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  7. Uri Landes
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  8. Ran Kornowski
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  9. Pablo Codner
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  10. Ole De Backer
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  11. Georg Nickenig
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  15. Federico De Marco
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  16. Marco Ancona
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  17. Matteo Montorfano
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  18. Damiano Regazzoli
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  19. Giulio Stefanini
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  20. Stefan Toggweiler
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  21. Corrado Tamburino
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  22. Sebastiano Immè
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  23. Giuseppe Tarantini
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  24. Horst Sievert
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  25. Ulrich Schäfer
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  26. Jörg Kempfert
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  27. Jochen Wöehrle
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  28. Maurizio Tespili
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  29. Alessandra Laricchia
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  30. Azeem Latib
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  31. Francesco Giannini
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  32. Antonio Colombo
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  33. Antonio Mangieri
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Corresponding author

Correspondence to Antonio Mangieri.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This is an observational study and was conducted from data obtained for clinical purposes. The BEAT (Balloon vs Self-Expandable valve for the treatment of bicuspid Aortic valve sTenosis) registry has been approved by local Ethical Committee.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Additional information

The original online version of this article was revised: The original version of this article, published on January 3, 2021, contained a mistake. The spelling of Arif Khokhar’s name was incorrect. The original article has been corrected.

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Bugani, G., Pagnesi, M., Tchetchè, D. et al. Predictors of high residual gradient after transcatheter aortic valve replacement in bicuspid aortic valve stenosis. Clin Res Cardiol 110, 667–675 (2021). https://doi.org/10.1007/s00392-020-01793-9

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  • DOI: https://doi.org/10.1007/s00392-020-01793-9

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