Transcatheter Aortic Valve Replacement in Patients with Aortic Stenosis Having Coronary Cusp Fusion versus Mixed Cusp Fusion Nonraphe Bicuspid Aortic Valve
Objectives. We aimed to assess the procedural and clinical results of transcatheter aortic valve replacement (TAVR) for nonraphe bicuspid aortic stenosis (AS) with coronary vs mixed cusp fusion. Background. It remains unclear whether cusp fusion morphology affects TAVR outcomes in patients with nonr...
Main Authors: | , , , , , , , , , , , |
---|---|
Format: | Article |
Language: | English |
Published: |
Hindawi-Wiley
2019-01-01
|
Series: | Journal of Interventional Cardiology |
Online Access: | http://dx.doi.org/10.1155/2019/7348964 |
id |
doaj-4ad02f97581f48428be4549fde914b27 |
---|---|
record_format |
Article |
spelling |
doaj-4ad02f97581f48428be4549fde914b272020-11-25T02:31:46ZengHindawi-WileyJournal of Interventional Cardiology0896-43271540-81832019-01-01201910.1155/2019/73489647348964Transcatheter Aortic Valve Replacement in Patients with Aortic Stenosis Having Coronary Cusp Fusion versus Mixed Cusp Fusion Nonraphe Bicuspid Aortic ValveWen-hua Lei0Yan-biao Liao1Zi-jie Wang2Yuan-weixiang Ou3Jiay-yu Tsauo4Yi-jian Li5Tian-yuan Xiong6Zhen-gang Zhao7Xin Wei8Wei Meng9Yuan Feng10Mao Chen11Department of Cardiology, West China Hospital, Sichuan University, 37 Guoxue Street, Chengdu 610041, ChinaDepartment of Cardiology, West China Hospital, Sichuan University, 37 Guoxue Street, Chengdu 610041, ChinaDepartment of Cardiology, West China Hospital, Sichuan University, 37 Guoxue Street, Chengdu 610041, ChinaDepartment of Cardiology, West China Hospital, Sichuan University, 37 Guoxue Street, Chengdu 610041, ChinaDepartment of Cardiology, West China Hospital, Sichuan University, 37 Guoxue Street, Chengdu 610041, ChinaDepartment of Cardiology, West China Hospital, Sichuan University, 37 Guoxue Street, Chengdu 610041, ChinaDepartment of Cardiology, West China Hospital, Sichuan University, 37 Guoxue Street, Chengdu 610041, ChinaDepartment of Cardiology, West China Hospital, Sichuan University, 37 Guoxue Street, Chengdu 610041, ChinaDepartment of Cardiology, West China Hospital, Sichuan University, 37 Guoxue Street, Chengdu 610041, ChinaDepartment of Cardiovascular Surgery, West China Hospital, Sichuan University, 37 Guoxue Street, Chengdu 610041, ChinaDepartment of Cardiology, West China Hospital, Sichuan University, 37 Guoxue Street, Chengdu 610041, ChinaDepartment of Cardiology, West China Hospital, Sichuan University, 37 Guoxue Street, Chengdu 610041, ChinaObjectives. We aimed to assess the procedural and clinical results of transcatheter aortic valve replacement (TAVR) for nonraphe bicuspid aortic stenosis (AS) with coronary vs mixed cusp fusion. Background. It remains unclear whether cusp fusion morphology affects TAVR outcomes in patients with nonraphe bicuspid AS. Methods. This retrospective study enrolled consecutive patients with severe symptomatic AS and type-0 bicuspid aortic valve, who underwent TAVR at our institution between 2012 and 2017. TAVR outcomes were defined based on the Valve Academic Research Consortium-2 recommendations. Results. Compared to patients with mixed cusp fusion (44/71), those with coronary cusp fusion (27/71) had a larger ellipticity index for the aortic annulus (21.9% ± 9.0% vs 15.6% ± 9.3%, p=0.007) and increased left ventricular outflow tract obstruction (31.1% ± 9.4% vs 26.9% ± 7.5%, p=0.04) but comparable rates of second valve implantation (15.9% vs 14.8%), mild paravalvular leakage (PVL, 38.5% vs 30.2%), permanent pacemaker implantation (PPM, 25.9% vs 15.9%), and 30-day mortality (7.4% vs 6.8%). Use of a first-generation transcatheter heart valve was associated with higher risk for mild PVL (odds ratio (OR) = 4.37; 95% confidence interval (95% CI) = 1.14–16.75; p=0.03) but not PPM (OR = 0.77; 95% CI = 0.22–2.62; p=0.67), whereas a larger oversizing ratio tended to be associated with a higher PPM rate (OR = 1.49; 95% CI = 0.46–4.86; p=0.51) but lower incidence of mild PVL (OR = 0.51; 95% CI = 0.19–1.35; p=0.17). Conclusions. In AS patients with type-0 bicuspid valves, cusp fusion morphology does not affect the procedural or clinical results of TAVR. Use of second-generation transcatheter heart valves may provide more favorable results in such patients. This trial is registered with NCT01683474.http://dx.doi.org/10.1155/2019/7348964 |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Wen-hua Lei Yan-biao Liao Zi-jie Wang Yuan-weixiang Ou Jiay-yu Tsauo Yi-jian Li Tian-yuan Xiong Zhen-gang Zhao Xin Wei Wei Meng Yuan Feng Mao Chen |
spellingShingle |
Wen-hua Lei Yan-biao Liao Zi-jie Wang Yuan-weixiang Ou Jiay-yu Tsauo Yi-jian Li Tian-yuan Xiong Zhen-gang Zhao Xin Wei Wei Meng Yuan Feng Mao Chen Transcatheter Aortic Valve Replacement in Patients with Aortic Stenosis Having Coronary Cusp Fusion versus Mixed Cusp Fusion Nonraphe Bicuspid Aortic Valve Journal of Interventional Cardiology |
author_facet |
Wen-hua Lei Yan-biao Liao Zi-jie Wang Yuan-weixiang Ou Jiay-yu Tsauo Yi-jian Li Tian-yuan Xiong Zhen-gang Zhao Xin Wei Wei Meng Yuan Feng Mao Chen |
author_sort |
Wen-hua Lei |
title |
Transcatheter Aortic Valve Replacement in Patients with Aortic Stenosis Having Coronary Cusp Fusion versus Mixed Cusp Fusion Nonraphe Bicuspid Aortic Valve |
title_short |
Transcatheter Aortic Valve Replacement in Patients with Aortic Stenosis Having Coronary Cusp Fusion versus Mixed Cusp Fusion Nonraphe Bicuspid Aortic Valve |
title_full |
Transcatheter Aortic Valve Replacement in Patients with Aortic Stenosis Having Coronary Cusp Fusion versus Mixed Cusp Fusion Nonraphe Bicuspid Aortic Valve |
title_fullStr |
Transcatheter Aortic Valve Replacement in Patients with Aortic Stenosis Having Coronary Cusp Fusion versus Mixed Cusp Fusion Nonraphe Bicuspid Aortic Valve |
title_full_unstemmed |
Transcatheter Aortic Valve Replacement in Patients with Aortic Stenosis Having Coronary Cusp Fusion versus Mixed Cusp Fusion Nonraphe Bicuspid Aortic Valve |
title_sort |
transcatheter aortic valve replacement in patients with aortic stenosis having coronary cusp fusion versus mixed cusp fusion nonraphe bicuspid aortic valve |
publisher |
Hindawi-Wiley |
series |
Journal of Interventional Cardiology |
issn |
0896-4327 1540-8183 |
publishDate |
2019-01-01 |
description |
Objectives. We aimed to assess the procedural and clinical results of transcatheter aortic valve replacement (TAVR) for nonraphe bicuspid aortic stenosis (AS) with coronary vs mixed cusp fusion. Background. It remains unclear whether cusp fusion morphology affects TAVR outcomes in patients with nonraphe bicuspid AS. Methods. This retrospective study enrolled consecutive patients with severe symptomatic AS and type-0 bicuspid aortic valve, who underwent TAVR at our institution between 2012 and 2017. TAVR outcomes were defined based on the Valve Academic Research Consortium-2 recommendations. Results. Compared to patients with mixed cusp fusion (44/71), those with coronary cusp fusion (27/71) had a larger ellipticity index for the aortic annulus (21.9% ± 9.0% vs 15.6% ± 9.3%, p=0.007) and increased left ventricular outflow tract obstruction (31.1% ± 9.4% vs 26.9% ± 7.5%, p=0.04) but comparable rates of second valve implantation (15.9% vs 14.8%), mild paravalvular leakage (PVL, 38.5% vs 30.2%), permanent pacemaker implantation (PPM, 25.9% vs 15.9%), and 30-day mortality (7.4% vs 6.8%). Use of a first-generation transcatheter heart valve was associated with higher risk for mild PVL (odds ratio (OR) = 4.37; 95% confidence interval (95% CI) = 1.14–16.75; p=0.03) but not PPM (OR = 0.77; 95% CI = 0.22–2.62; p=0.67), whereas a larger oversizing ratio tended to be associated with a higher PPM rate (OR = 1.49; 95% CI = 0.46–4.86; p=0.51) but lower incidence of mild PVL (OR = 0.51; 95% CI = 0.19–1.35; p=0.17). Conclusions. In AS patients with type-0 bicuspid valves, cusp fusion morphology does not affect the procedural or clinical results of TAVR. Use of second-generation transcatheter heart valves may provide more favorable results in such patients. This trial is registered with NCT01683474. |
url |
http://dx.doi.org/10.1155/2019/7348964 |
work_keys_str_mv |
AT wenhualei transcatheteraorticvalvereplacementinpatientswithaorticstenosishavingcoronarycuspfusionversusmixedcuspfusionnonraphebicuspidaorticvalve AT yanbiaoliao transcatheteraorticvalvereplacementinpatientswithaorticstenosishavingcoronarycuspfusionversusmixedcuspfusionnonraphebicuspidaorticvalve AT zijiewang transcatheteraorticvalvereplacementinpatientswithaorticstenosishavingcoronarycuspfusionversusmixedcuspfusionnonraphebicuspidaorticvalve AT yuanweixiangou transcatheteraorticvalvereplacementinpatientswithaorticstenosishavingcoronarycuspfusionversusmixedcuspfusionnonraphebicuspidaorticvalve AT jiayyutsauo transcatheteraorticvalvereplacementinpatientswithaorticstenosishavingcoronarycuspfusionversusmixedcuspfusionnonraphebicuspidaorticvalve AT yijianli transcatheteraorticvalvereplacementinpatientswithaorticstenosishavingcoronarycuspfusionversusmixedcuspfusionnonraphebicuspidaorticvalve AT tianyuanxiong transcatheteraorticvalvereplacementinpatientswithaorticstenosishavingcoronarycuspfusionversusmixedcuspfusionnonraphebicuspidaorticvalve AT zhengangzhao transcatheteraorticvalvereplacementinpatientswithaorticstenosishavingcoronarycuspfusionversusmixedcuspfusionnonraphebicuspidaorticvalve AT xinwei transcatheteraorticvalvereplacementinpatientswithaorticstenosishavingcoronarycuspfusionversusmixedcuspfusionnonraphebicuspidaorticvalve AT weimeng transcatheteraorticvalvereplacementinpatientswithaorticstenosishavingcoronarycuspfusionversusmixedcuspfusionnonraphebicuspidaorticvalve AT yuanfeng transcatheteraorticvalvereplacementinpatientswithaorticstenosishavingcoronarycuspfusionversusmixedcuspfusionnonraphebicuspidaorticvalve AT maochen transcatheteraorticvalvereplacementinpatientswithaorticstenosishavingcoronarycuspfusionversusmixedcuspfusionnonraphebicuspidaorticvalve |
_version_ |
1724822091837997056 |