Transcatheter aortic valve replacement achieves similar predicted effective orifice area to surgical aortic valve replacement in bicuspid aortic stenosis

John E Connolly; Howard C Herrmann; Pavan Atluri; Nimesh Desai; Paul N Fiorilli; Jay Giri; Robert H Li; Taisei Kobayashi; Ashwin S Nathan; Wilson Y Szeto; Joshua C Grimm

doi:10.1016/j.carrev.2024.03.017

Transcatheter aortic valve replacement achieves similar predicted effective orifice area to surgical aortic valve replacement in bicuspid aortic stenosis

Cardiovasc Revasc Med. 2024 Mar 21:S1553-8389(24)00105-2. doi: 10.1016/j.carrev.2024.03.017. Online ahead of print.

Authors

Affiliations

¹ Department of Internal Medicine, Johns Hopkins Hospital, Baltimore, MD 21224, USA.
² Division of Cardiovascular Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA 19104, USA.
³ Division of Cardiovascular Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA 19104, USA.
⁴ Division of Cardiovascular Medicine, Penn Presbyterian Medical Center, Philadelphia, PA 19104, USA.
⁵ Division of Cardiovascular Surgery, Penn Presbyterian Medical Center, Philadelphia, PA 19104, USA.
⁶ Institute for Cardiovascular Health, University of Texas Health Austin, Austin, TX 78712, USA. Electronic address: joshua.grimm@austin.utexas.edu.

PMID: 38553277
DOI: 10.1016/j.carrev.2024.03.017

Abstract

Background: Studies comparing transcatheter and surgical aortic valve replacement (TAVR and SAVR) for patients with trileaflet aortic stenosis (AS) have found similar or larger effective orifice area (EOA) for TAVR prostheses. To our knowledge, no studies have compared EOA in patients undergoing TAVR versus SAVR for bicuspid AS.

Methods: We retrospectively compared prosthetic valvular sizing and predicted EOA for patients with bicuspid AS undergoing TAVR or SAVR at our institution between January 1, 2016, and December 31, 2021. We excluded patients undergoing procedures for indications other than AS and those without a pre-procedural gated Chest CT. Comparisons included demographics, comorbidities, annular size, prosthetic valve size, predicted EOA and prosthesis-patient mismatch (PPM) for TAVR (N = 78) and SAVR (N = 74) cohorts.

Results: TAVR patients had smaller pre-procedural annular area (501.7 mm² vs. 571.8 mm², p < 0.05) and annular perimeter (80.6 mm vs. 86.5 mm, p < 0.05), but larger mean implanted prosthetic valve size (26.4 mm vs 24.2 mm, p < 0.001) compared to SAVR patients. No differences were observed in predicted EOA, predicted EOA indexed to patient body surface area (EOAi), or predicted PPM grade between TAVR and SAVR groups, including in cohorts sorted by pre-procedural annular size.

Conclusions: For bicuspid AS patients undergoing aortic valve replacement, TAVR achieves similar predicted EOA to SAVR. These data support the use of TAVR in selected patients with bicuspid AS and can inform heart team discussions.

Keywords: Bicuspid aortic stenosis; SAVR; TAVR.