TRANSCATHETER AORTIC VALVE IMPLANTATION WITH SAPIEN XT OR SAPIEN 3 PROSTHESES IN BICUSPID AORTIC VALVE DISEASE

116 JACC April 5, 2016 Volume 67, Issue 13

ACC.i2 Interventional Cardiology TRANSCATHETER AORTIC VALVE IMPLANTATION WITH SAPIEN XT OR SAPIEN 3 PROSTHESES IN BICUSPID AORTIC VALVE DISEASE Poster Contributions Poster Area, South Hall A1 Saturday, April 02, 2016, 3:45 p.m.-4:30 p.m. Session Title: Aortic Valve Disease: General and Clinical Outcomes Abstract Category: 3. ACC.i2 Interventional Cardiology: Aortic Valve Disease Presentation Number: 1141-109 Authors: Hiroyuki Kawamori, Yoshio Maeno, Yigal Abramowitz, Nobuyuki Takahashi, Yoshio Kazuno, Mohammad Kashif, Tarun Chakravarty, Wen Cheng, Raj Makkar, Hasan Jilaihawi, Cedars-Sinai Heart Institute, Los Angeles, CA, USA

Background: Little is known about trans-catheter aortic valve implantation (TAVI) for patients with bicuspid aortic valve (BAV) stenosis.

Methods: From January 2013 to July 2015, 412 patients with severe native aortic valve stenosis (tricuspid aortic valve [TAV] 361 patients and BAV 51 patients) had contrast computed tomography with good quality before TAVI using Sapien XT or Sapien 3 in our hospital.

Results: BAV patients, in comparison to TAV patients, had larger annulus area (497.9±81.5mm2 vs 468.3±99.6 mm2; p=0.04), annulus perimeter (80.0±6.6mm vs 77.2±10.0mm; p=0.04) and leaflet calcium volume (850-HU threshold) (404.6±362.9mm3 vs 232.5±250.9mm3; p<0.01). Pre-procedure mean aortic valve gradient on transthoracic echocardiography was higher in BAV than in TAV (50.4±16.6 mmHg vs 45.3±12.3 mmHg; p=0.02). Between the TAV and BAV patients, there was no difference in clinical outcome both Sapien XT and Sapien 3(table). In TAV disease, there was less paravalvular leak (PVL)≥mild with Sapien 3 vs XT (13.5% vs 32.7%, p<0.01) but there was no significant difference PVL in BAV disease with Sapien 3 vs XT (22.2% vs 48.5%, p=0.12).

Conclusions: Although BAV patients had larger annulus size, higher leaflet calcium volume and higher mean gradient than TAV patients, there was no difference in clinical outcomes after balloon-expandable TAVI. Balloon-expandable TAVI with Sapien XT or Sapien 3 appears feasible and safe in BAV anatomy in the setting of careful planning using cross-sectional imaging in all cases. Clinical outcome Device success, n (%) Hospital stay (days), mean±SD Major bleeding, n (%) Myocardial infarction, n (%) Stroke or TIA event, n (%) Major vascular complication, n (%) Tamponade, n (%) Permanent pacemaker Implantation, n (%)

Valve embolization, n (%) TTE Ejection Fraction (%), TTE Mean gradient (mmHg) TTE paravalvular leakage ≥mild, n (%) TTE paravalvular leakage ≥moderate, n (%)

30 Day mortality, n (%) TTE: transthoracic echocardiography

TAV XT(n=220) 216 (98.1) 5.2±4.2 7 (3.2) 2 (1.0) 11 (5.0) 4 (1.8) 1 (0.5)

BAV XT(n=33) 32 (97.0) 4.4±3.0 1(3.0) 0(0.0) 0(0.0) 1(3.0) 0(0.0)

p 0.838 0.197 0.626 0.614 0.392 0.838 0.271

18 (8.2)

3 (10.3)

2 (0.9) 58.2±13.8 10.0±4.9

TAV S3(n=141) 140 (99.2) 3.6±2.4 3 (2.1) 0 (0.0) 0 (0.0) 2 (1.4) 0 (0.0)

BAV S3(n=18) 17(94.4) 3.5±1.0 0 (0.0) 0 (0.0) 1 (5.6) 0 (0.0) 0 (0.0)

p 0.539 0.745 0.768

0.945 16(13.3)

2(12.5)

0.764

0(0.0) 53.1±17.8 9.3±3.1

0.614 0 (0.0) 0.269 59.5±11.1 0.647 10.7±4.0

0 (0.0) 61.8±12.5 10.9±4.9

0.420 0.861

72 (32.7)

16 (48.5)

0.115 19 (13.5)

4 (22.2)

0.523

6 (2.7)

0(0.0)

0.729 0 (0.0)

0 (0.0)

3 (1.4)

0(0.0)

0.851 0 (0.0)

0 (0.0)

0.838 0.539