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Which TAVI Device is best suited for the bicuspid valve?
Jürg Grünenfelder1, Sacha Salzberg2, Tim Aeppli3, Patric Biaggi1, Roberto Corti1.
1Heart Clinic, Zurich, Switzerland, 2Heart Clinic, Zurich, Switzerland, Zurich, Switzerland, 3Universityhospital Zurich, Zurich, Switzerland.
OBJECTIVE: The aim of this study was to compare two commercially available in regard to all valvular leaks after Transcatheter Aortic Valve Implantation (TAVI) in patients with a bicuspid aortic valve (BAV) stenosis. BAV has long been considered as a contraindication to TAVI, but recent studies have demonstrated good clinical outcome after TAVI for these patients. No comparative study has yet been conducted evaluating the two commercially available devices.
METHODS: TAVI was performed in 12 individuals with BAV at our Institution from May 2008 to December 2012. The Edwards SAPIEN (n=4) and the Medtronic CoreValve (n=8) prostheses were implanted by either transfemoral or transapical access. Clinical outcomes and Echocardiography are reported according to the Valve Academic Research Consortium (VARC) Criteria and assessed using the latest documented visit within one year of intervention in our dedicated core lab.
RESULTS: A symptomatic and hemodynamic improvement was seen in all but one patient, who died of a gastro-intestinal catastrophy 2 days after successful Sapien implantation (STS score 5.9%). A reduction of the mean valvular gradient after TAVI intervention was noticed and in both patient groups. All patients were in NYHA class I or II after the procedure, compared to NYHA-class III (50%) and IV (25%) before. The left ventricular ejection fraction was improved or unchanged in 75% of the patients with no difference between the two groups. Paravalvular regurgiation was trivial or mild except for two (one CoreValve and one SAPIEN), both having moderate paravalvular regurgitation. One patient with Corevalve required a pacemaker, while two Sapien patients had a significant central leakage.
CONCLUSIONS: In our experience both types of valves can safely be used in BAV patients. Hemodynamics are improved after TAVI in the BAV setting. From our limited results, and the current literature, we conclude that BAV is no longer a contraindication to TAVI. Further data is necessary to substantiate our conclusions.
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