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PERFORMANCE OF TRANSCATHETER AORTIC VALVE IMPLANTATION IN PATIENTS WITH BICUSPID AORTIC VALVE: SYSTEMATIC REVIEW
Abstracts
composite outcomes were calculated. Hypotheses of a difference in DAPT vs. mono-antiplatelet therapy were evaluated at an alpha level of 0.05. RESULTS: Our search strategy yielded 91 studies of which 3 studies met inclusion: 1 randomized controlled trial and 2 prospective cohort studies. In total, 520 patients were included (466 trans-femoral approach, 54 trans-apical approach), with 226 in the DAPT group (combined ASA and clopidogrel) and 294 patients in the mono-antiplatelet therapy group (2 studies ASA alone, 1 study ASA or clopidogrel alone). In comparison of DAPT versus mono-antiplatelet therapy, there was no difference in 30-day spontaneous MI (OR 0.59, [95% CI 0.09 - 4.07], p¼0.59, I2¼ 0%), 30-day major stroke (OR 1.61, [95% CI 0.36 7.15], p¼0.53, I2¼ 14%), 30-day cardiovascular death (OR 1.28, [95% CI 0.67 - 2.45], p¼0.45, I2¼ 0%), and combined 30-day MI and/or stroke (OR 1.31, [95% CI 0.43 - 3.97], p¼0.64, I2¼ 0%). Patients in the DAPT group experienced increased major bleeding (OR 3.46, [95% CI 1.71 - 6.99], p¼0.0006, I2¼ 0%), and increased combined 30-day MI/stroke/cardiovascular death/major bleeding (OR 2.13, [95% CI 1.30 - 3.48], p¼0.003, I2¼ 12%). CONCLUSION: The results of this meta-analysis show that DAPT post-TAVI compared to mono-antiplatelet therapy alone increases the risk of major bleeding, with no clear benefit in reduction of 30-day MI, stroke, and/or cardiovascular death. Given the limitations of the pooled analysis (such as small sample size and observational studies), the optimal antiplatelet regimen post-TAVI should be explored in a large randomized controlled trial.
S97
080 PERFORMANCE OF TRANSCATHETER AORTIC VALVE IMPLANTATION IN PATIENTS WITH BICUSPID AORTIC VALVE: SYSTEMATIC REVIEW A Yousef, T Simard, A Pourdjabbar, B Hibbert, J Webb, M Le May, C Glover, M Labinaz, A Chong, D So Ottawa, Ontario OBJECTIVE:
To systematically review the current experience and outcomes of TAVI performance in patients with stenotic bicuspid aortic valves. BACKGROUND: Transcatheter Aortic Valve Implantation (TAVI) is the current standard of care for managing patients with severely stenotic aortic valve that are considered to be of high operative risk. However, major clinical trials thus far have excluded patients with bicuspid aortic valve (BAV), resulting in current guidelines listing BAV as a contraindication for TAVI. We conducted a systematic review to describe the outcomes of TAVI in patients with BAV. METHODOLOGY: We performed a computerized literature search of SCOPUS until February 2014 for all English language studies using following search terms: TAVI, TAVR and bicuspid or congenital aortic valve. Additional studies were identified using references and citations of identified studies. Inclusion criteria are patients with documented bicuspid aortic valve undergoing TAVI and who reported a primary endpoint of 30-day mortality. RESULTS: We identified 292 studies of which, only 10 case series and case reports met criteria for inclusion in the review. This encompassed a total of 92 patients who underwent TAVI for BAV up until February 2014. The primary endpoint of 30 day mortality (8.6% vs. 5.0%) and 1-year mortality rate (15% vs. 3.7%) were similar to those reported in tricuspid Aortic valve patients undergoing TAVI in Partner-B trial. Secondary endpoints were variable, with lower stroke events (0% vs. 6.7%) and higher rates of pacemaker insertion (21% vs. 3.4%) and major vascular complications (23% vs. 16%). CONCLUSION: In this systematic review, TAVI performance in patients with bicuspid aortic valves appears to have comparable outcomes to that of tricuspid aortic valve. However, the paucity of available data precludes further conclusions, with larger dedicated studies being required to definitively elucidate the role of TAVI for BAV patients.
composite outcomes were calculated. Hypotheses of a difference in DAPT vs. mono-antiplatelet therapy were evaluated at an alpha level of 0.05. RESULTS: Our search strategy yielded 91 studies of which 3 studies met inclusion: 1 randomized controlled trial and 2 prospective cohort studies. In total, 520 patients were included (466 trans-femoral approach, 54 trans-apical approach), with 226 in the DAPT group (combined ASA and clopidogrel) and 294 patients in the mono-antiplatelet therapy group (2 studies ASA alone, 1 study ASA or clopidogrel alone). In comparison of DAPT versus mono-antiplatelet therapy, there was no difference in 30-day spontaneous MI (OR 0.59, [95% CI 0.09 - 4.07], p¼0.59, I2¼ 0%), 30-day major stroke (OR 1.61, [95% CI 0.36 7.15], p¼0.53, I2¼ 14%), 30-day cardiovascular death (OR 1.28, [95% CI 0.67 - 2.45], p¼0.45, I2¼ 0%), and combined 30-day MI and/or stroke (OR 1.31, [95% CI 0.43 - 3.97], p¼0.64, I2¼ 0%). Patients in the DAPT group experienced increased major bleeding (OR 3.46, [95% CI 1.71 - 6.99], p¼0.0006, I2¼ 0%), and increased combined 30-day MI/stroke/cardiovascular death/major bleeding (OR 2.13, [95% CI 1.30 - 3.48], p¼0.003, I2¼ 12%). CONCLUSION: The results of this meta-analysis show that DAPT post-TAVI compared to mono-antiplatelet therapy alone increases the risk of major bleeding, with no clear benefit in reduction of 30-day MI, stroke, and/or cardiovascular death. Given the limitations of the pooled analysis (such as small sample size and observational studies), the optimal antiplatelet regimen post-TAVI should be explored in a large randomized controlled trial.
S97
080 PERFORMANCE OF TRANSCATHETER AORTIC VALVE IMPLANTATION IN PATIENTS WITH BICUSPID AORTIC VALVE: SYSTEMATIC REVIEW A Yousef, T Simard, A Pourdjabbar, B Hibbert, J Webb, M Le May, C Glover, M Labinaz, A Chong, D So Ottawa, Ontario OBJECTIVE:
To systematically review the current experience and outcomes of TAVI performance in patients with stenotic bicuspid aortic valves. BACKGROUND: Transcatheter Aortic Valve Implantation (TAVI) is the current standard of care for managing patients with severely stenotic aortic valve that are considered to be of high operative risk. However, major clinical trials thus far have excluded patients with bicuspid aortic valve (BAV), resulting in current guidelines listing BAV as a contraindication for TAVI. We conducted a systematic review to describe the outcomes of TAVI in patients with BAV. METHODOLOGY: We performed a computerized literature search of SCOPUS until February 2014 for all English language studies using following search terms: TAVI, TAVR and bicuspid or congenital aortic valve. Additional studies were identified using references and citations of identified studies. Inclusion criteria are patients with documented bicuspid aortic valve undergoing TAVI and who reported a primary endpoint of 30-day mortality. RESULTS: We identified 292 studies of which, only 10 case series and case reports met criteria for inclusion in the review. This encompassed a total of 92 patients who underwent TAVI for BAV up until February 2014. The primary endpoint of 30 day mortality (8.6% vs. 5.0%) and 1-year mortality rate (15% vs. 3.7%) were similar to those reported in tricuspid Aortic valve patients undergoing TAVI in Partner-B trial. Secondary endpoints were variable, with lower stroke events (0% vs. 6.7%) and higher rates of pacemaker insertion (21% vs. 3.4%) and major vascular complications (23% vs. 16%). CONCLUSION: In this systematic review, TAVI performance in patients with bicuspid aortic valves appears to have comparable outcomes to that of tricuspid aortic valve. However, the paucity of available data precludes further conclusions, with larger dedicated studies being required to definitively elucidate the role of TAVI for BAV patients.