SPC365

Transcatheter Aortic Valve Replacement and Bicuspid Aortic Valve

Session: Sessão de Posters 08 - Intervenção estrutural: TAVI
Speaker: Fernando Lima do Nascimento Ferreira

Congress: CPC 2024
Topic: H. Interventional Cardiology and Cardiovascular Surgery
Theme: 25. Interventional Cardiology
Subtheme: 25.3 Non-coronary Cardiac Intervention
Session Type: Cartazes
FP Number: ---
Authors: Fernando Nascimento Ferreira; Inês Rodrigues; Miguel Figueiredo; Bárbara Teixeira; Francisco Albuquerque; Ricardo Carvalheiro; Tiago Mendonça; Andre Grazina; Duarte Cacela; Ruben Ramas; António Fiarresga; Rui Cruz Ferreira

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Introduction:</strong> Bicuspid aortic valve (BAV) is the most common congenital heart disease and is closely associated with the development of valve defect, particularly stenosis. In this context, transcatheter aortic valve replacement (TAVR) has gained a role in the management of these patients despite the lack of clinical evidence. </span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Objective: </strong>To evaluate potential differences between individuals undergoing TAVR with and without BAV <span style="color:black">anatomy</span>.</span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Methodology: </strong><span style="color:black">Consecutive patients with severe aortic stenosis who underwent TAVR between 2017 and 2023 in a single center were included</span>. Two groups were defined based on the diagnosis of BAV using Computed Tomography Angiography. Baseline demographic, clinical and imaging characteristics were evaluated. Technical success, safety and efficacy endpoints according to the Valve Academy Research Consortium-2 (VARC 2) criteria were compared using the Chi-square test, Fisher&#39;s exact test, Mann-Whitney U test, and multinomial logistic regression, with a p-value considered statistically significant when &lt;0.05.</span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Results: </strong>A total of 803 individuals underwent TAVR (21 with BAV Group), with a median age of 83 years and 54.5% being male. BAV pts were younger (79 (46) Vs 83 (37) p=0,001) and had a higher prevalence of smoking (42.9% vs. 11.6%, p=0.00), stage 5 CKD (19% vs. 2.3%, p=0.002), and lung disease (38.1% vs. 19.2%, p=0.047), with no significant differences in surgical risk scores. No significant differences were found between groups in mean transvalvular gradient, AV area, prevalence of aortic regurgitation, and AV calcium score. However, the diameter of the valve annulus was significantly higher in the BAV group (26mm (7.2) vs. 23mm (16.7), p=0.001).</span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">Regarding the BAV group, the most frequent type <span style="color:black">of BAV classification was Sievers type 1 (61.9%), 52.4% of which, with fusion of right and left coronary cusps</span><span style="color:#00b050">. </span>Moderate aorta calcification was observed in 47.6% of cases, and the mean ascending aorta diameter was 42&plusmn;6mm.</span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><span style="color:black">There were no significant differences in procedural success (100% BAV Vs 94,5%, p=0,622) and immediate post-procedural valve performance (mean gradient &gt; 20 mmHg 4,8% Vs 6,9% p1,0; moderate to severe leak 4,8% Vs 4,9% p=1,0). Peri-procedural safety endpoints were similar in both groups except with arrhythmias (23.8% in BAV vs. 51.3%, OR 0.295 (0.107-0.814), p=0.014).</span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">At 1 year follow up, there was a higher <span style="color:black">prevalence of intra-prosthetic regurgitation after procedure in the BAV group (9.5% vs. 1.4%, OR 7.378 (1.529-35.601), p=0.043, but no significant differences in the prevalence of stroke, HF,</span>hospitalizations or mortality.</span></span></span></p>

<p style="text-align:start"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Conclusion: </strong>TAVR is a safe and effective procedure in BAV patients as in tricuspid AV patients. Besides similar valve performance immediately after the procedure, the occurrence of valve degeneration seems higher at 1 year of FUP. Larger-scale studies are needed to validate these results.</span></span></span></p>