Impact of Balloon-Expandable TAVR Valve Deformation and Calcium Distribution on Outcomes in Bicuspid Aortic Valve.

Autor:	Nagasaka T; Cedars-Sinai Medical Center, Smidt Heart Institute, Los Angeles, California, USA; Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine, Gunma, Japan., Patel V; Cedars-Sinai Medical Center, Smidt Heart Institute, Los Angeles, California, USA., Shechter A; Cedars-Sinai Medical Center, Smidt Heart Institute, Los Angeles, California, USA; Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel., Suruga K; Cedars-Sinai Medical Center, Smidt Heart Institute, Los Angeles, California, USA., Koren O; Cedars-Sinai Medical Center, Smidt Heart Institute, Los Angeles, California, USA; Bruce Rappaport Faculty of Medicine, Technion Israel Institute of Technology, Haifa, Israel., Chakravarty T; Cedars-Sinai Medical Center, Smidt Heart Institute, Los Angeles, California, USA., Cheng W; Cedars-Sinai Medical Center, Smidt Heart Institute, Los Angeles, California, USA., Ishii H; Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine, Gunma, Japan., Jilaihawi H; Cedars-Sinai Medical Center, Smidt Heart Institute, Los Angeles, California, USA., Nakamura M; Cedars-Sinai Medical Center, Smidt Heart Institute, Los Angeles, California, USA., Makkar RR; Cedars-Sinai Medical Center, Smidt Heart Institute, Los Angeles, California, USA. Electronic address: raj.makkar@cshs.org.
Jazyk:	angličtina
Zdroj:	JACC. Cardiovascular interventions [JACC Cardiovasc Interv] 2024 Sep 09; Vol. 17 (17), pp. 2023-2037.
DOI:	10.1016/j.jcin.2024.07.018
Abstrakt:	Background: Research on the role of transcatheter heart valve (THV) deformation and calcium distribution in patients with bicuspid aortic valves (BAVs) undergoing transcatheter aortic valve replacement (TAVR) remains limited. Objectives: The aim of this study was to evaluate the impact of THV deformation on clinical outcomes in individuals with BAVs undergoing TAVR and the influence of calcium on these outcomes. Methods: In total, 229 consecutive patients with BAVs who underwent TAVR with balloon-expandable valves and had computed tomography (CT) performed 30 days post-TAVR were analyzed. Patients were stratified into 3 groups: group 1 (n = 125), with no THV underexpansion or eccentricity; group 2 (n = 69), with underexpansion or eccentricity; and group 3 (n = 35), with both. Calcium distribution was assessed using CT, and its associations with clinical outcomes, including all-cause mortality at 3 years and leaflet thrombosis at 30 days, were determined. A subgroup analysis of patients with type 1 BAVs was conducted. Results: Group 3 exhibited higher rates of all-cause mortality than the other groups, along with the highest risk for hypoattenuated leaflet thickening at 30 days. Multivariate analysis identified annular and left ventricular outflow tract calcification as independent predictors of all-cause mortality and hypoattenuated leaflet thickening. In patients with type 1 BAVs, excessive calcification at the raphe and opposite leaflet were associated with all-cause mortality at 3 years. Conclusions: THV deformation post-TAVR was significantly linked to all-cause mortality in patients with BAVs. Annular and left ventricular outflow tract calcification correlated with increased risks for all-cause mortality and leaflet thrombosis. (Assessment of Transcatheter and Surgical Aortic Bioprosthetic Valve Thrombosis and Its Treatment With Anticoagulation [RESOLVE]; NCT02318342). Competing Interests: Funding Support and Author Disclosures Dr Makkar has received grant support from Edwards Lifesciences; is a consultant for Abbott Vascular, Cordis, and Medtronic; and holds equity in Entourage Medical. Dr Chakravarty is a consultant, proctor, and speaker for Edwards Lifesciences and Medtronic; is a consultant for Abbott Lifesciences; and is a consultant and speaker for Boston Scientific. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. (Copyright © 2024 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.)
Databáze:	MEDLINE
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