Transcatheter aortic valve implantation for bicuspid aortic valve stenosis: Acute and intermediate-term outcomes in a high volume institution

Abstract

Background: We report our experience with transcatheter aortic valve implantation (TAVI) in patients with bicuspid aortic valve (BAV) stenosis. Methods: Perioperative and intermediate-term follow-up data were retrospectively analysed. All procedures were performed within the premises of an experienced high-volume TAVI centre. Results: Thirty-three consecutive BAV patients (age 55 to 87 years) underwent TAVI. Mean logistic European System for Cardiac Operative Risk Evaluation (EuroSCORE) was 23,2 ± 19,3. Transapical Edwards Sapien® valve was implanted in the majority of patients (87.9%). Nine patients (27.3%) required post-ballooning of the implanted valve for moderate to severe paravalvular leak, 3 patients (9%) required a second valve implantation for persistent severe paravalvular leak, and 2 (6%) required conversion to conventional surgery. Post-operative mild aortic regurgitation (AR) was presented in 12 patients (36.4%) and AR = 2 in 3%. No AR > 2 was observed. The device success rate according to the valve academic research consortium (VARC) criteria was 82%. Similar BAV anatomy, calcium distribution, type and size of implanted valve were noticed in patients with and without residual AR. There was no thirty-day mortality. Two-year estimated survival was 70% (CI: 52.7–93.1) and was similar in patients with and without post-procedural residual paravalvular leak. Conclusions: TAVI in BAV stenosis is feasible but, even in experienced centres, is technically more challenging and is associated with a higher rate of post-dilatation, revalving, and conversion to conventional surgery. Results should be re-tested in light of the recent introduction of second-generation TAVI prostheses.