Abstract 17567: Bicuspid Aortic Valve Disease: Anatomical Characteristics and Stent Frame Geometry Following Sapien 3 Transcatheter Aortic Valve Implantation
Introduction: Patients with Bicuspid aortic valve (BAV) disease have been excluded from clinical trial because of anatomical variations and safety considerations.
Hypothesis: Patients with BAV that undergo TAVI may have an increased risk of uneven expansion and subsequent dysfunction of the transcatheter heart valve.
Methods: We included consecutive patients from the RESOLVE registry (NCT02318342) that had a contrast CT before and after TAVI and had Sapien 3 implantation. BAV patients were divided into tricommissural BAV and bicommissural BAV.
Results: A total of 127 patients had Sapien 3 implantation, 27 with BAV and 100 with tricuspid aortic valve (TAV). BAV patients had larger sino-tubular junction (STJ) diameter (30.1±3.5mm vs. 28.4±3.1; p=0.029), aorta dimension (35.7±4.1 mm vs. 33.6±3.1 mm; p<0.01) and leaflet calcium volume (850-HU threshold: 391.7±333.3 mm3 vs. 212.1±178.9 mm3; p<0.01). The THV stent-frame at mid-level and outflow-level eccentricity indexes in BAV patients were lower compared to TAV patients (mid-level 3.9±3.3% vs 5.6±4.4%; P=0.041, outflow-level 3.4±2.6 % vs. 5.1±3.7%; P=0.01). Valve expansion ratio at each level was similar. Device success in BAV patients trended to be lower (85.1% vs. 96%; p=0.062). Other CT measurements and clinical outcomes are shown in the Table.
Conclusions: BAV patients had larger STJ size, aorta size, and higher leaflet calcium volume. Eccentricy indexes of Sapien 3 THV in BAV patients were lower than in TAV patients, but expansion ratio of this valve was similar between BAV and TAV patients. TAVI with Sapien 3 in BAV patients appears to result in a feasible THV stent-frame geometry and similar clinical outcomes although device success was lower.
Author Disclosures: H. Kawamori: None. Y. Abramowitz: None. T. Chakravarty: None. Y. Maeno: None. Y. Kazuno: None. N. Takahashi: None. M. Kashif: None. G. Mangat: None. W. Cheng: None. R. Makkar: Research Grant; Modest; Edwards Lifesciences Corporation, St. Jude Medical. Consultant/Advisory Board; Modest; Abbott Vascular, Cordis, Medtronic. H. Jilaihawi: Consultant/Advisory Board; Modest; Edwards Lifesciences Corporation, St. Jude Medical, Venus MedTech.
- © 2016 by American Heart Association, Inc.