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. 2022 Apr 11;15(7):712-724.
doi: 10.1016/j.jcin.2022.01.282.

Risk of Coronary Obstruction During Redo-TAVR in Patients With Bicuspid Versus Tricuspid Aortic Valve Stenosis

Fei Chen  1 , Tianyuan Xiong  1 , Yijian Li  1 , Xi Wang  1 , Zhongkai Zhu  1 , Yijun Yao  1 , Yuanweixiang Ou  1 , Xi Li  1 , Xin Wei  1 , Zhengang Zhao  1 , Qiao Li  1 , Sen He  1 , Jiafu Wei  1 , Yong Peng  1 , Yuan Feng  1 , Mao Chen  2
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Free article

Risk of Coronary Obstruction During Redo-TAVR in Patients With Bicuspid Versus Tricuspid Aortic Valve Stenosis

Fei Chen et al. JACC Cardiovasc Interv. .
Free article

Abstract

Objectives: The aim of this study was to investigate the risk of coronary obstruction during redo-transcatheter aortic valve replacement (TAVR) within a previously implanted self-expanding valve in bicuspid aortic valve (BAV) versus tricuspid aortic valve (TAV) stenosis.

Background: The prevalence of BAV in TAVR patients is expected to increase as the indication expands; however, no study has investigated the risk of coronary obstruction for future redo-TAVR in these patients.

Methods: Computed tomography (CT) simulation analysis was performed in 86 type 0 BAV, 70 type 1 BAV, and 132 TAV patients who underwent TAVR with 1 VenusA-Valve (Venus Medtech) between January 2014 and December 2019.

Results: CT-identified risk of coronary obstruction during redo-TAVR was observed in 36.1% of patients for the left coronary ostium (LCO) and 27.8% of patients for the right coronary ostium (RCO); however, the incidences were significantly lower in the type 0 BAV group than in the type 1 BAV or TAV group (for LCO: OR: 1.00 [reference] vs OR: 2.49; 95% CI: 1.24-5.01 vs OR: 2.60; 95% CI: 1.40-4.81; for RCO: OR: 1.00 [reference] vs OR: 2.14; 95% CI: 1.02-4.48 vs OR: 1.97; 95% CI: 1.02-3.80). The leaflet laceration technique may be unfeasible to improve coronary flow in 61.5% of the threatened LCOs and 58.8% of the threatened RCOs during redo-TAVR. The percentages were significantly or numerically lower in the type 0 BAV group than other groups (for LCO: 26.3% vs 62.1% vs 73.2%; P overall = 0.001; for RCO: 43.8% vs 65.2% vs 61.0%; P overall = 0.374).

Conclusions: Differences in anatomical features may impact the feasibility of future redo-TAVR. Type 0 BAV anatomy was associated with the lower incidence of CT-identified risk of coronary obstruction during redo-TAVR, and the leaflet laceration technique may be more feasible to ensure coronary flow in this population.

Keywords: BASILICA; bicuspid aortic valve; coronary obstruction; redo-TAVR.

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Conflict of interest statement

Funding Support and Author Disclosures This work was supported by the National Natural Science Foundation of China (81970325, 82102129 and 82170375); West China Hospital “1·3·5” Discipline of Excellence Project-“Percutaneous transcatheter aortic valve implantation” and “Mechanisms of aortic stenosis and the clinical applications. Drs Mao Chen and Yuan Feng are consultants of Venus MedTech. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

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