Transcatheter aortic valve replacement in the treatment of bicuspid aortic stenosis with “down-size” interventional valves: procedural and mid-term follow-up

Background: Due to the influence of anatomical structure, replacing the bicuspid valve using transcatheter aortic valve replacement (TAVR) would increase the risk of perivalvular leakage and conduction block, affecting the hemodynamic effect of the interventional valve. In this study, for bicuspid a...

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Autores: Liu, Kun, Wu, Kaisheng, Shen, Jinglun, Meng, Fei, Nappi, Francesco, Alfonso Manterola, Fernando, Wang, Shengxun, Zheng, Shuai, Zhang, Haibo
Tipo de recurso: artículo
Fecha de publicación:2024
País:España
Institución:Universidad Autónoma de Madrid
Repositorio:Biblos-e Archivo. Repositorio Institucional de la UAM
Idioma:inglés
OAI Identifier:oai:dnet:biblosearchi::16272d087303e94e29f5ac8ee147db13
Acceso en línea:https://hdl.handle.net/10486/761480
https://dx.doi.org/10.21037/jtd-23-1885
Access Level:acceso abierto
Palabra clave:Transcatheter aortic valve replacement (TAVR)
bicuspid aortic valve (BAV)
tricuspid aortic valve (TAV)
valve size selection
Medicina
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spelling Transcatheter aortic valve replacement in the treatment of bicuspid aortic stenosis with “down-size” interventional valves: procedural and mid-term follow-upLiu, KunWu, KaishengShen, JinglunMeng, FeiNappi, FrancescoAlfonso Manterola, FernandoWang, ShengxunZheng, ShuaiZhang, HaiboTranscatheter aortic valve replacement (TAVR)bicuspid aortic valve (BAV)tricuspid aortic valve (TAV)valve size selectionMedicinaBackground: Due to the influence of anatomical structure, replacing the bicuspid valve using transcatheter aortic valve replacement (TAVR) would increase the risk of perivalvular leakage and conduction block, affecting the hemodynamic effect of the interventional valve. In this study, for bicuspid and tricuspid valves, we implemented different valve selection strategies to explore the safety and effectiveness of TAVR in the treatment of bicuspid aortic stenosis with “down-size” interventional valves using the VenusA-valve system. Methods: The operation was performed with the VenusA-valve via transfemoral approach. The selected valves were appropriately sized based on the results of transthoracic echocardiography (TTE), contrast-enhanced computed tomography (CT), and the morphology of intraoperative pre-dilation balloons. For tricuspid valve cases, the VenusA valve is usually larger than the annulus diameter, whereas the “down-size” approach was adopted for bicuspid aortic valve (BAV) cases. The shape of the pre-dilation balloon allowed further sizing of the annulus diameter by the degree of lumbar constriction of the balloon, aiding in intervention valve size selection, particularly in cases of BAVs. Results: A total of 65 patients underwent TAVR for aortic stenosis with VenusA-valve systems. Of these, 29 cases had a BAV and 36 cases had a tricuspid aortic valve (TAV). The distribution of VenusA-valve sizes differed between TAV and BAV cases (P=0.007). Furthermore, there was a significant decrease in the average mean gradient in TAV patients from 54.7 to 12.2 mmHg (P<0.001), and in BAV patients from 61.6 to 14.3 mmHg (P<0.001). The percentage of paravalvular leakage greater than mild was 6.90% in the BAVs and 5.56% in the TAVs at procedural outcomes (P=0.955). The mean follow-up period was 22.23 months (range, 12 to 39 months). The proportion of New York Heart Association (NYHA) class III/IV decreased from 78.5% preoperatively to 11.3% at the last follow-up (P<0.001). A total of 27 patients with TAV and 19 patients with BAV underwent TTE at 1-year follow-up after operation. There was no significant contrast in the average pressure difference between TAVs and BAVs at 1-year follow-up (11.9 vs. 14.3 mmHg, P=0.18). Conclusions: The VenusA-valve for TAVR produced positive clinical outcomes and valve functionality in both BAVs and TAVs. In the case of BAVs, selecting a smaller interventional valve size was deemed viableThis study was funded by the Natural Science Foundation of Beijing Municipality (No.D171100002917003), the National Key R&D Program of China (No. 2020YFC2008105), and the Capital Health Research and Development of Special (No. 2020-2)AME PublishingDepartamento de MedicinaFacultad de Medicina20242024-01-30research articlehttp://purl.org/coar/resource_type/c_2df8fbb1VoRhttp://purl.org/coar/version/c_970fb48d4fbd8a85info:eu-repo/semantics/articleapplication/pdfhttps://hdl.handle.net/10486/761480https://dx.doi.org/10.21037/jtd-23-188538410558reponame:Biblos-e Archivo. Repositorio Institucional de la UAMinstname:Universidad Autónoma de MadridInglésengopen accesshttp://purl.org/coar/access_right/c_abf2Attribution-NonCommercial-NoDerivatives 4.0 Internationalhttp://creativecommons.org/licenses/by-nc-nd/4.0/info:eu-repo/semantics/openAccessoai:dnet:biblosearchi::16272d087303e94e29f5ac8ee147db132026-06-23T12:46:27Z
dc.title.none.fl_str_mv Transcatheter aortic valve replacement in the treatment of bicuspid aortic stenosis with “down-size” interventional valves: procedural and mid-term follow-up
title Transcatheter aortic valve replacement in the treatment of bicuspid aortic stenosis with “down-size” interventional valves: procedural and mid-term follow-up
spellingShingle Transcatheter aortic valve replacement in the treatment of bicuspid aortic stenosis with “down-size” interventional valves: procedural and mid-term follow-up
Liu, Kun
Transcatheter aortic valve replacement (TAVR)
bicuspid aortic valve (BAV)
tricuspid aortic valve (TAV)
valve size selection
Medicina
title_short Transcatheter aortic valve replacement in the treatment of bicuspid aortic stenosis with “down-size” interventional valves: procedural and mid-term follow-up
title_full Transcatheter aortic valve replacement in the treatment of bicuspid aortic stenosis with “down-size” interventional valves: procedural and mid-term follow-up
title_fullStr Transcatheter aortic valve replacement in the treatment of bicuspid aortic stenosis with “down-size” interventional valves: procedural and mid-term follow-up
title_full_unstemmed Transcatheter aortic valve replacement in the treatment of bicuspid aortic stenosis with “down-size” interventional valves: procedural and mid-term follow-up
title_sort Transcatheter aortic valve replacement in the treatment of bicuspid aortic stenosis with “down-size” interventional valves: procedural and mid-term follow-up
dc.creator.none.fl_str_mv Liu, Kun
Wu, Kaisheng
Shen, Jinglun
Meng, Fei
Nappi, Francesco
Alfonso Manterola, Fernando
Wang, Shengxun
Zheng, Shuai
Zhang, Haibo
author Liu, Kun
author_facet Liu, Kun
Wu, Kaisheng
Shen, Jinglun
Meng, Fei
Nappi, Francesco
Alfonso Manterola, Fernando
Wang, Shengxun
Zheng, Shuai
Zhang, Haibo
author_role author
author2 Wu, Kaisheng
Shen, Jinglun
Meng, Fei
Nappi, Francesco
Alfonso Manterola, Fernando
Wang, Shengxun
Zheng, Shuai
Zhang, Haibo
author2_role author
author
author
author
author
author
author
author
dc.contributor.none.fl_str_mv Departamento de Medicina
Facultad de Medicina
dc.subject.none.fl_str_mv Transcatheter aortic valve replacement (TAVR)
bicuspid aortic valve (BAV)
tricuspid aortic valve (TAV)
valve size selection
Medicina
topic Transcatheter aortic valve replacement (TAVR)
bicuspid aortic valve (BAV)
tricuspid aortic valve (TAV)
valve size selection
Medicina
description Background: Due to the influence of anatomical structure, replacing the bicuspid valve using transcatheter aortic valve replacement (TAVR) would increase the risk of perivalvular leakage and conduction block, affecting the hemodynamic effect of the interventional valve. In this study, for bicuspid and tricuspid valves, we implemented different valve selection strategies to explore the safety and effectiveness of TAVR in the treatment of bicuspid aortic stenosis with “down-size” interventional valves using the VenusA-valve system. Methods: The operation was performed with the VenusA-valve via transfemoral approach. The selected valves were appropriately sized based on the results of transthoracic echocardiography (TTE), contrast-enhanced computed tomography (CT), and the morphology of intraoperative pre-dilation balloons. For tricuspid valve cases, the VenusA valve is usually larger than the annulus diameter, whereas the “down-size” approach was adopted for bicuspid aortic valve (BAV) cases. The shape of the pre-dilation balloon allowed further sizing of the annulus diameter by the degree of lumbar constriction of the balloon, aiding in intervention valve size selection, particularly in cases of BAVs. Results: A total of 65 patients underwent TAVR for aortic stenosis with VenusA-valve systems. Of these, 29 cases had a BAV and 36 cases had a tricuspid aortic valve (TAV). The distribution of VenusA-valve sizes differed between TAV and BAV cases (P=0.007). Furthermore, there was a significant decrease in the average mean gradient in TAV patients from 54.7 to 12.2 mmHg (P<0.001), and in BAV patients from 61.6 to 14.3 mmHg (P<0.001). The percentage of paravalvular leakage greater than mild was 6.90% in the BAVs and 5.56% in the TAVs at procedural outcomes (P=0.955). The mean follow-up period was 22.23 months (range, 12 to 39 months). The proportion of New York Heart Association (NYHA) class III/IV decreased from 78.5% preoperatively to 11.3% at the last follow-up (P<0.001). A total of 27 patients with TAV and 19 patients with BAV underwent TTE at 1-year follow-up after operation. There was no significant contrast in the average pressure difference between TAVs and BAVs at 1-year follow-up (11.9 vs. 14.3 mmHg, P=0.18). Conclusions: The VenusA-valve for TAVR produced positive clinical outcomes and valve functionality in both BAVs and TAVs. In the case of BAVs, selecting a smaller interventional valve size was deemed viable
publishDate 2024
dc.date.none.fl_str_mv 2024
2024-01-30
dc.type.none.fl_str_mv research article
http://purl.org/coar/resource_type/c_2df8fbb1
VoR
http://purl.org/coar/version/c_970fb48d4fbd8a85
dc.type.openaire.fl_str_mv info:eu-repo/semantics/article
format article
dc.identifier.none.fl_str_mv https://hdl.handle.net/10486/761480
https://dx.doi.org/10.21037/jtd-23-1885
38410558
url https://hdl.handle.net/10486/761480
https://dx.doi.org/10.21037/jtd-23-1885
identifier_str_mv 38410558
dc.language.none.fl_str_mv Inglés
eng
language_invalid_str_mv Inglés
language eng
dc.rights.none.fl_str_mv open access
http://purl.org/coar/access_right/c_abf2
Attribution-NonCommercial-NoDerivatives 4.0 International
http://creativecommons.org/licenses/by-nc-nd/4.0/
dc.rights.openaire.fl_str_mv info:eu-repo/semantics/openAccess
rights_invalid_str_mv open access
http://purl.org/coar/access_right/c_abf2
Attribution-NonCommercial-NoDerivatives 4.0 International
http://creativecommons.org/licenses/by-nc-nd/4.0/
eu_rights_str_mv openAccess
dc.format.none.fl_str_mv application/pdf
dc.publisher.none.fl_str_mv AME Publishing
publisher.none.fl_str_mv AME Publishing
dc.source.none.fl_str_mv reponame:Biblos-e Archivo. Repositorio Institucional de la UAM
instname:Universidad Autónoma de Madrid
instname_str Universidad Autónoma de Madrid
reponame_str Biblos-e Archivo. Repositorio Institucional de la UAM
collection Biblos-e Archivo. Repositorio Institucional de la UAM
repository.name.fl_str_mv
repository.mail.fl_str_mv
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