Hemodynamic and Conduction System Outcomes in Sievers Type 0 and Sievers Type 1 Bicuspid Aortic Valves Post Transcatheter Aortic Valve Replacement

Kris Kumar, Timothy F. Simpson, Reyhaneh Akhavein, Katherine Rajotte, Segolene Weller, Cristina Fuss, Howard K. Song, Harsh Golwala, Firas Zahr, Scott M. Chadderdon

Research output: Contribution to journalArticlepeer-review

Abstract

Background: A retrospective analysis of severe bicuspid aortic stenosis was performed to evaluate hemodynamic profiles and incidence of adverse conduction effects in Sievers Type 0 compared to Sievers Type 1 morphologies after transcatheter aortic valve replacement (TAVR) with a self-expanding prosthesis. In the past decade there has been a transition to treating lower risk patients with TAVR. While overall outcomes in patients with bicuspid aortic valves (BAV) have improved, hemodynamic and conduction system challenges still exist. Methods: Moderate- to high-risk patients with BAV who underwent TAVR with a self-expanding prosthesis from 01/01/2017 to 09/01/2019 were reviewed. Transthoracic echocardiographic (TTE) and electrocardiogram (ECG) data were analyzed at baseline and at 30-day follow-up. Computed tomography (CT) of the aortic annulus was analyzed in all patients pre-TAVR and in a subset of 10 patients post-TAVR. Results: The cohort consisted of 10 Sievers Type 0 and 20 Sievers Type 1 patients, mean age 68 y, and Society of Thoracic Surgeons (STS) risk 4.6 ± 3.7%. Post-TAVR, Sievers Type 1 BAV had a superior hemodynamic profile, with lower gradients and less paravalvular leak compared to Type 0. Post-TAVR valve eccentricity was unchanged in Type 1 but markedly altered in Type 0 BAV. Conversely, Type 1 BAV demonstrated an increased incidence of new left bundle branch block (LBBB). Conclusions: Sievers Type 1 anatomy was associated with a superior hemodynamic profile but an increased incidence of LBBB when compared to Sievers Type 0 post-TAVR. As TAVR shifts to a lower risk cohort, understanding how BAV morphologies affect long-term hemodynamics and conduction abnormalities warrants continued study. Abbreviations: AS: aortic stenosis; AV: aortic valve; AVA: aortic valve area; BAV: bicuspid aortic valve; CT: computed tomography; CTA: computed tomography angiography; DVI: dimensionless index; ECG: electrocardiogram; EI: eccentricity index LBBB: left bundle branch block; LVEF: left ventricular ejection fraction; LVOT: left ventricular outflow tract; NYHA: New York Heart Association Classification; PVL: paravalvular leak; PPM: permanent pacemaker; SAVR: surgical aortic valve replacement; STS: Society of Thoracic Surgeons; SV: stroke volume; TAVR: transcatheter aortic valve replacement; TTE: transthoracic echocardiogram; VARC-2: Valve Academic Research Consortium 2.

Original languageEnglish (US)
Pages (from-to)287-294
Number of pages8
JournalStructural Heart
Volume5
Issue number3
DOIs
StatePublished - 2021

Keywords

  • aortic stenosis
  • Bicuspid aortic valve
  • outcomes
  • Sievers classification
  • transcatheter aortic valve replacement

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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