The Presence of Calcified Raphe Is an Independent Predictor of Adverse Long-Term Clinical Outcomes in Patients With Bicuspid Aortic Stenosis Undergoing Transcatheter Aortic Valve Replacement

Yung-Tsai Lee; Wei-Hsian Yin; Tien-Ping Tsao; Kuo-Chen Lee; Ming-Chon Hsiung; Yun-Hsuan Tzeng; Jeng Wei

doi:10.3389/fcvm.2022.767906

The Presence of Calcified Raphe Is an Independent Predictor of Adverse Long-Term Clinical Outcomes in Patients With Bicuspid Aortic Stenosis Undergoing Transcatheter Aortic Valve Replacement

Front Cardiovasc Med. 2022 Apr 13:9:767906. doi: 10.3389/fcvm.2022.767906. eCollection 2022.

Authors

Yung-Tsai Lee^{1

2}, Wei-Hsian Yin^{1

3}, Tien-Ping Tsao^{1

4}, Kuo-Chen Lee^{1

4}, Ming-Chon Hsiung¹, Yun-Hsuan Tzeng^{3

5}, Jeng Wei^{1

4}

Affiliations

¹ Heart Center, Cheng Hsin General Hospital, Taipei, Taiwan.
² Institute of Microbiology and Immunology, National Yang Ming Chiao Tung University, Taipei, Taiwan.
³ Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.
⁴ Faculty of Medicine, National Defense Medical Center, Taipei, Taiwan.
⁵ Division of Medical Imaging, Health Management Center, Cheng Hsin General Hospital, Taipei, Taiwan.

Abstract

Objective: Current guidelines recommend that transcatheter aortic valve replacement (TAVR) for bicuspid aortic valve (BAV) with aortic stenosis (AS) should only be performed in selected patients. However, we consider it even more crucial to identify what the really important factors are while determining long-term outcomes in patients with BAV undergoing TAVR, which is precisely the aim of this study.

Methods: We retrospectively evaluated consecutive patients who underwent TAVR with balloon-expandable Sapien XT or Sapien 3 valves (Edwards Lifesciences, Irvine, CA) for the treatment of severe bicuspid AS. The primary end points were major adverse cardiac and cerebral events (MACCE), that is, mortality, non-fatal myocardial infarction (MI), disabling stroke, valve failure needing reintervention, or clinically relevant valve thrombosis during follow-up.

Results: A total of 56 patients who underwent TAVR with Sapien XT (n = 20) or Sapien 3 (n = 36) were included. The device and procedural success rates were similar between the two TAVR valves; however, the newer-generation Sapien 3 yielded a trend toward better long-term clinical outcomes than the early-generation Sapien XT did (MACCE rates 35 vs. 11%, p = 0.071). In the multivariate Cox proportional hazards analyses, the presence of calcified raphe > 4 mm was the only independent predictor of long-term MACCE (hazard ratio: 6.76; 95% confidence interval: 1.21-37.67, p = 0.029).

Conclusion: TAVR performed by a skilled heart team, while using newer-generation balloon-expandable Sapien 3 valve, may yield better long-term clinical outcomes compared to TAVR using early-generation Sapien XT valve. Moreover, the presence of calcified raphe >4 mm is an independent determinant of adverse clinical outcomes.

Keywords: aortic stenosis; balloon-expandable valve; bicuspid aortic valve; calcified raphe; clinical outcomes; transcatheter aortic valve replacement; valve calcification.