PMID- 38410558
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20240229
IS  - 2072-1439 (Print)
IS  - 2077-6624 (Electronic)
IS  - 2072-1439 (Linking)
VI  - 16
IP  - 1
DP  - 2024 Jan 30
TI  - Transcatheter aortic valve replacement in the treatment of bicuspid aortic 
      stenosis with "down-size" interventional valves: procedural and mid-term 
      follow-up.
PG  - 593-603
LID - 10.21037/jtd-23-1885 [doi]
AB  - BACKGROUND: Due to the influence of anatomical structure, replacing the bicuspid 
      valve using transcatheter aortic valve replacement (TAVR) would increase the risk 
      of perivalvular leakage and conduction block, affecting the hemodynamic effect of 
      the interventional valve. In this study, for bicuspid and tricuspid valves, we 
      implemented different valve selection strategies to explore the safety and 
      effectiveness of TAVR in the treatment of bicuspid aortic stenosis with 
      "down-size" interventional valves using the VenusA-valve system. METHODS: The 
      operation was performed with the VenusA-valve via transfemoral approach. The 
      selected valves were appropriately sized based on the results of transthoracic 
      echocardiography (TTE), contrast-enhanced computed tomography (CT), and the 
      morphology of intraoperative pre-dilation balloons. For tricuspid valve cases, 
      the VenusA valve is usually larger than the annulus diameter, whereas the 
      "down-size" approach was adopted for bicuspid aortic valve (BAV) cases. The shape 
      of the pre-dilation balloon allowed further sizing of the annulus diameter by the 
      degree of lumbar constriction of the balloon, aiding in intervention valve size 
      selection, particularly in cases of BAVs. RESULTS: A total of 65 patients 
      underwent TAVR for aortic stenosis with VenusA-valve systems. Of these, 29 cases 
      had a BAV and 36 cases had a tricuspid aortic valve (TAV). The distribution of 
      VenusA-valve sizes differed between TAV and BAV cases (P=0.007). Furthermore, 
      there was a significant decrease in the average mean gradient in TAV patients 
      from 54.7 to 12.2 mmHg (P<0.001), and in BAV patients from 61.6 to 14.3 mmHg 
      (P<0.001). The percentage of paravalvular leakage greater than mild was 6.90% in 
      the BAVs and 5.56% in the TAVs at procedural outcomes (P=0.955). The mean 
      follow-up period was 22.23 months (range, 12 to 39 months). The proportion of New 
      York Heart Association (NYHA) class III/IV decreased from 78.5% preoperatively to 
      11.3% at the last follow-up (P<0.001). A total of 27 patients with TAV and 19 
      patients with BAV underwent TTE at 1-year follow-up after operation. There was no 
      significant contrast in the average pressure difference between TAVs and BAVs at 
      1-year follow-up (11.9 vs. 14.3 mmHg, P=0.18). CONCLUSIONS: The VenusA-valve for 
      TAVR produced positive clinical outcomes and valve functionality in both BAVs and 
      TAVs. In the case of BAVs, selecting a smaller interventional valve size was 
      deemed viable.
CI  - 2024 Journal of Thoracic Disease. All rights reserved.
FAU - Liu, Kun
AU  - Liu K
AD  - Department of Cardiac Surgery, Cardiovascular Medical Center, the University of 
      Hong Kong-Shenzhen Hospital, Shenzhen, China.
FAU - Wu, Kaisheng
AU  - Wu K
AD  - Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical 
      University, Beijing, China.
FAU - Shen, Jinglun
AU  - Shen J
AD  - Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical 
      University, Beijing, China.
FAU - Meng, Fei
AU  - Meng F
AD  - Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical 
      University, Beijing, China.
FAU - Nappi, Francesco
AU  - Nappi F
AD  - Department of Cardiac Surgery, Centre Cardiologique du Nord, Saint-Denis, France.
FAU - Alfonso, Fernando
AU  - Alfonso F
AD  - Department of Cardiology, Hospital Universitario de La Princesa, Universidad 
      Autonoma de Madrid, CIBERCV, IIS-IP, Madrid, Spain.
FAU - Wang, Shengxun
AU  - Wang S
AD  - Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical 
      University, Beijing, China.
FAU - Zheng, Shuai
AU  - Zheng S
AD  - Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical 
      University, Beijing, China.
FAU - Zhang, Haibo
AU  - Zhang H
AD  - Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical 
      University, Beijing, China.
LA  - eng
PT  - Journal Article
DEP - 20240122
PL  - China
TA  - J Thorac Dis
JT  - Journal of thoracic disease
JID - 101533916
PMC - PMC10894397
OTO - NOTNLM
OT  - Transcatheter aortic valve replacement (TAVR)
OT  - bicuspid aortic valve (BAV)
OT  - tricuspid aortic valve (TAV)
OT  - valve size selection
COIS- Conflicts of Interest: All authors have completed the ICMJE uniform disclosure 
      form (available at 
      https://jtd.amegroups.com/article/view/10.21037/jtd-23-1885/coif). The authors 
      have no conflicts of interest to declare.
EDAT- 2024/02/27 06:45
MHDA- 2024/02/27 06:46
PMCR- 2024/01/30
CRDT- 2024/02/27 03:41
PHST- 2023/12/12 00:00 [received]
PHST- 2024/01/16 00:00 [accepted]
PHST- 2024/02/27 06:46 [medline]
PHST- 2024/02/27 06:45 [pubmed]
PHST- 2024/02/27 03:41 [entrez]
PHST- 2024/01/30 00:00 [pmc-release]
AID - jtd-16-01-593 [pii]
AID - 10.21037/jtd-23-1885 [doi]
PST - ppublish
SO  - J Thorac Dis. 2024 Jan 30;16(1):593-603. doi: 10.21037/jtd-23-1885. Epub 2024 Jan 
      22.