Feasibility and Outcomes of Transcatheter Aortic Valve Implantation in High-Risk Patients With Stenotic Bicuspid Aortic Valves

Little is known about transcatheter aortic valve implantation (TAVI) in patients with bicuspid aortic valve stenosis, which usually represents a contraindication. The aim of this study was to assess the feasibility and the results of TAVI in this patient subset. Of 316 high-risk patients with severe aortic stenosis who underwent TAVI from January 2009 to January 2012, 15 (5%) had documented bicuspid aortic valves. They were treated using a transarterial approach, using the Medtronic Core Valve system. Patients were aged 80 +/- 10 years, in New York Heart Association functional classes III and IV. The mean aortic valve area was 0.8 +/- 0.3 cm(2), and the mean gradient was 60 +/- 19 mm Hg. The mean calcium score, calculated using multislice computed tomography, was 4,553 +/- 1,872 arbitrary units. The procedure was successful in all but 1 patient. Major adverse events, according to Valvular Academic Research Consortium definitions, were encountered in 1 patient (death). The mean postimplantation prosthetic gradient was 11 +/- 4 mm Hg, and <= 1+ periprosthetic leaks were observed in all but 2 patients. The mean prosthetic ellipticity index was 0.7 +/- 0.2 at the level of the native annulus and 0.8 0.2 at the level of the prosthetic leaflets. After a mean follow-up period of 8 +/- 7 months, 1 patient had died from aortic dissection; there were no additional adverse events. All but 2 hospital survivors were in New York Heart Association class I or II. In conclusion, the present series suggests that transarterial Medtronic Core Valve implantation is feasible in selected patients with bicuspid aortic valve and may lead to short-term hemodynamic and clinical improvement. (C) 2012 Elsevier Inc. All rights reserved. (Am J Cardiol 2012; 110:877-883)