A Bicuspid Aortic Valve Imaging Classification for the TAVR Era

Hasan Jilaihawi; Mao Chen; John Webb; Dominique Himbert; Carlos E. Ruiz; Josep Rodés-Cabau; Gregor Pache; Antonio Colombo; Georg Nickenig; Michael Lee; Corrado Tamburino; Horst Sievert; Yigal Abramowitz; Giuseppe Tarantini; Faisal Alqoofi; Tarun Chakravarty; Mohammad Kashif; Nobuyuki Takahashi; Yoshio Kazuno; Yoshio Maeno; Hiroyuki Kawamori; Alaide Chieffo; Philipp Blanke; Danny Dvir; Henrique Barbosa Ribeiro; Yuan Feng; Zhen Gang Zhao; Jan Malte Sinning; Chad Kliger; Gennaro Giustino; Basia Pajerski; Sebastiano Imme; Eberhard Grube; Jonathon Leipsic; Alec Vahanian; Iassen Michev; Vladimir Jelnin; Azeem Latib; Wen Cheng; Raj Makkar

doi:10.1016/j.jcmg.2015.12.022

A Bicuspid Aortic Valve Imaging Classification for the TAVR Era

Hasan Jilaihawi, Mao Chen, John Webb, Dominique Himbert, Carlos E. Ruiz, Josep Rodés-Cabau, Gregor Pache, Antonio Colombo, Georg Nickenig, Michael Lee, Corrado Tamburino, Horst Sievert, Yigal Abramowitz, Giuseppe Tarantini, Faisal Alqoofi, Tarun Chakravarty, Mohammad Kashif, Nobuyuki Takahashi, Yoshio Kazuno, Yoshio MaenoHiroyuki Kawamori, Alaide Chieffo, Philipp Blanke, Danny Dvir, Henrique Barbosa Ribeiro, Yuan Feng, Zhen Gang Zhao, Jan Malte Sinning, Chad Kliger, Gennaro Giustino, Basia Pajerski, Sebastiano Imme, Eberhard Grube, Jonathon Leipsic, Alec Vahanian, Iassen Michev, Vladimir Jelnin, Azeem Latib, Wen Cheng, Raj Makkar

Research output: Contribution to journal › Article › peer-review

150 Scopus citations

Abstract

Objectives This study sought to evaluate transcatheter aortic valve replacement (TAVR) in bicuspid aortic valve (BAV) aortic stenosis (AS), with a particular emphasis on TAVR-directed bicuspid aortic valve imaging (BAVi) of morphological classification. Background TAVR has been used to treat BAV-AS but with heterogeneous outcomes and uncertainty regarding the relevance of morphology. Methods In 14 centers in the United States, Canada, Europe, and Asia, 130 BAV-AS patients underwent TAVR. Baseline cardiac computed tomography (CT) was analyzed by a dedicated Corelab. Outcomes were assessed in line with Valve Academic Research Consortium criteria. Results Bicommissural BAV (vs. tricommissural) accounted for 68.9% of those treated in North America, 88.9% in Europe, and 95.5% in Asia (p = 0.003). For bicommissural bicuspids, non-raphe type (vs. raphe type) BAV accounted for 11.9% of those treated in North America, 9.4% in Europe, and 61.9% in Asia (p < 0.001). Overall rates of 30-day mortality (3.8%) and cerebrovascular events (3.2%) were favorable and similar among anatomical subsets. The rate of new permanent pacemaker insertion was high (26.2%) and similar between balloon-expandable (BE) and self-expanding (SE) designs (BE: 25.5% vs. SE: 26.9%; p = 0.83); there was a trend to greater permanent pacemaker insertion in BE TAVR in the presence of coronary cusp fusion BAV morphology. Paravalvular aortic regurgitation (PAR) ≥ moderate was 18.1% overall but lower at 11.5% in those with pre-procedural CT. In the absence of pre-procedural CT, there was an excess of PAR in BE TAVR that was not the case in those with a pre-procedural CT; SE TAVR required more post-dilation. Predictors of PAR included intercommissural distance for bicommissural bicuspids (odd ratio [OR]: 1.37; 95% confidence interval [CI]: 1.02 to 1.84; p = 0.036) and lack of a baseline CT for annular measurement (OR: 3.03; 95% CI: 1.20 to 7.69; p = 0.018). Conclusions In this multicenter study, TAVR achieved favorable outcomes in patients with pre-procedural CT, with the exception of high permanent pacemaker rates for all devices and shapes.

Original language	English (US)
Pages (from-to)	1145-1158
Number of pages	14
Journal	JACC: Cardiovascular Imaging
Volume	9
Issue number	10
DOIs	https://doi.org/10.1016/j.jcmg.2015.12.022
State	Published - Oct 1 2016
Externally published	Yes

Keywords

TAVI
TAVR
aortic stenosis
aortic valve replacement
bicuspid aortic valve
transcatheter aortic valve implantation
transcatheter aortic valve replacement

ASJC Scopus subject areas

Radiology Nuclear Medicine and imaging
Cardiology and Cardiovascular Medicine

Access to Document

10.1016/j.jcmg.2015.12.022

Cite this

Jilaihawi, H., Chen, M., Webb, J., Himbert, D., Ruiz, C. E., Rodés-Cabau, J., Pache, G., Colombo, A., Nickenig, G., Lee, M., Tamburino, C., Sievert, H., Abramowitz, Y., Tarantini, G., Alqoofi, F., Chakravarty, T., Kashif, M., Takahashi, N., Kazuno, Y., ... Makkar, R. (2016). A Bicuspid Aortic Valve Imaging Classification for the TAVR Era. JACC: Cardiovascular Imaging, 9(10), 1145-1158. https://doi.org/10.1016/j.jcmg.2015.12.022

Jilaihawi, H, Chen, M, Webb, J, Himbert, D, Ruiz, CE, Rodés-Cabau, J, Pache, G, Colombo, A, Nickenig, G, Lee, M, Tamburino, C, Sievert, H, Abramowitz, Y, Tarantini, G, Alqoofi, F, Chakravarty, T, Kashif, M, Takahashi, N, Kazuno, Y, Maeno, Y, Kawamori, H, Chieffo, A, Blanke, P, Dvir, D, Ribeiro, HB, Feng, Y, Zhao, ZG, Sinning, JM, Kliger, C, Giustino, G, Pajerski, B, Imme, S, Grube, E, Leipsic, J, Vahanian, A, Michev, I, Jelnin, V, Latib, A, Cheng, W & Makkar, R 2016, 'A Bicuspid Aortic Valve Imaging Classification for the TAVR Era', JACC: Cardiovascular Imaging, vol. 9, no. 10, pp. 1145-1158. https://doi.org/10.1016/j.jcmg.2015.12.022

@article{bc4e429421f0405ab1f6f1de07e0daaf,

title = "A Bicuspid Aortic Valve Imaging Classification for the TAVR Era",

abstract = "Objectives This study sought to evaluate transcatheter aortic valve replacement (TAVR) in bicuspid aortic valve (BAV) aortic stenosis (AS), with a particular emphasis on TAVR-directed bicuspid aortic valve imaging (BAVi) of morphological classification. Background TAVR has been used to treat BAV-AS but with heterogeneous outcomes and uncertainty regarding the relevance of morphology. Methods In 14 centers in the United States, Canada, Europe, and Asia, 130 BAV-AS patients underwent TAVR. Baseline cardiac computed tomography (CT) was analyzed by a dedicated Corelab. Outcomes were assessed in line with Valve Academic Research Consortium criteria. Results Bicommissural BAV (vs. tricommissural) accounted for 68.9% of those treated in North America, 88.9% in Europe, and 95.5% in Asia (p = 0.003). For bicommissural bicuspids, non-raphe type (vs. raphe type) BAV accounted for 11.9% of those treated in North America, 9.4% in Europe, and 61.9% in Asia (p < 0.001). Overall rates of 30-day mortality (3.8%) and cerebrovascular events (3.2%) were favorable and similar among anatomical subsets. The rate of new permanent pacemaker insertion was high (26.2%) and similar between balloon-expandable (BE) and self-expanding (SE) designs (BE: 25.5% vs. SE: 26.9%; p = 0.83); there was a trend to greater permanent pacemaker insertion in BE TAVR in the presence of coronary cusp fusion BAV morphology. Paravalvular aortic regurgitation (PAR) ≥ moderate was 18.1% overall but lower at 11.5% in those with pre-procedural CT. In the absence of pre-procedural CT, there was an excess of PAR in BE TAVR that was not the case in those with a pre-procedural CT; SE TAVR required more post-dilation. Predictors of PAR included intercommissural distance for bicommissural bicuspids (odd ratio [OR]: 1.37; 95% confidence interval [CI]: 1.02 to 1.84; p = 0.036) and lack of a baseline CT for annular measurement (OR: 3.03; 95% CI: 1.20 to 7.69; p = 0.018). Conclusions In this multicenter study, TAVR achieved favorable outcomes in patients with pre-procedural CT, with the exception of high permanent pacemaker rates for all devices and shapes.",

keywords = "TAVI, TAVR, aortic stenosis, aortic valve replacement, bicuspid aortic valve, transcatheter aortic valve implantation, transcatheter aortic valve replacement",

author = "Hasan Jilaihawi and Mao Chen and John Webb and Dominique Himbert and Ruiz, {Carlos E.} and Josep Rod{\'e}s-Cabau and Gregor Pache and Antonio Colombo and Georg Nickenig and Michael Lee and Corrado Tamburino and Horst Sievert and Yigal Abramowitz and Giuseppe Tarantini and Faisal Alqoofi and Tarun Chakravarty and Mohammad Kashif and Nobuyuki Takahashi and Yoshio Kazuno and Yoshio Maeno and Hiroyuki Kawamori and Alaide Chieffo and Philipp Blanke and Danny Dvir and Ribeiro, {Henrique Barbosa} and Yuan Feng and Zhao, {Zhen Gang} and Sinning, {Jan Malte} and Chad Kliger and Gennaro Giustino and Basia Pajerski and Sebastiano Imme and Eberhard Grube and Jonathon Leipsic and Alec Vahanian and Iassen Michev and Vladimir Jelnin and Azeem Latib and Wen Cheng and Raj Makkar",

note = "Funding Information: Dr. Jilaihawi is a consultant for Edwards Lifesciences, St. Jude Medical, Venus, and Medtech. Dr. Makkar has received grants from Edwards Lifesciences; and personal fees from St. Jude Medical and Medtronic. Dr. Webb is a consultant for Edwards Lifesciences. Dr. Himbert is a consultant and proctor for Edwards Lifesciences and Medtronic. Dr. Ruiz has a financial relationship with Philips and St. Jude Medical; and has received educational grant(s) from Philips Healthcare. Dr. Sievert has received fees for consulting and travel and honoraria from Abbott, Access Closure, AGA, Angiomed, Aptus, Atrium, Avinger, Bard, Boston Scientific, Bridgepoint, Carag, Cardiac Dimensions, CardioKinetix, CardioMEMS, Cardiox, Celonova, CGuard, Coherex, Contego, Covidien, CSI, CVRx, EndoCross, ev3, FlowCardia, Gardia, Gore, Guided Delivery Systems, Hemoteq, InSeal Medical, Lumen Biomedical, HLT, Lifetech, Lutonix, Maya Medical, Medtronic, NDC, Occlutech, Osprey, Ostial, PendraCare, pfm Medical, Recor, ResMed, Rox Medical, SentreHeart, Spectranetics, SquareOne, Svelte Medical Systems, Trireme, Trivascular, Vascular Dynamics, Venus Medical, Veryan, and Vessix; owns stock options in Cardiokinetix, Access Closure, Velocimed, Lumen Biomedical, Coherex, and SMT; and has received grants from Cook and St. Jude Medical. Dr. Blanke is a consultant for Edwards Lifesciences, Neovasc, Tendyne, and Consultant Circle Imaging. Dr. Sinning has received honoraria from Medtronic, Edwards Lifesciences, Abbott, Direct Flow Medical; and has received research grants from Medtronic, Edwards Lifesciences, and Boston Scientific. Dr. Kliger has financial relationships with St. Jude Medical and Philips Healthcare. Dr. Leipsic has financial relationships with Edwards Lifesciences and Circl CVI. Dr. Vahanian has received honoraria from Abbott Vascular, Edwards Lifesciences, and Valtech. Dr. Michev is a proctor for Medtronic Corevalve and Boston Scientific. Dr. Latib is a consultant for Medtronic and Direct Flow Medical. Dr. Makkar is a consultant for Abbott Vascular, Cordis, and Medtronic; and has received grants from Edwards Lifesciences and St. Jude Medical. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. Publisher Copyright: {\textcopyright} 2016 American College of Cardiology Foundation",

year = "2016",

month = oct,

day = "1",

doi = "10.1016/j.jcmg.2015.12.022",

language = "English (US)",

volume = "9",

pages = "1145--1158",

journal = "JACC: Cardiovascular Imaging",

issn = "1936-878X",

publisher = "Elsevier Inc.",

number = "10",

}

TY - JOUR

T1 - A Bicuspid Aortic Valve Imaging Classification for the TAVR Era

AU - Jilaihawi, Hasan

AU - Chen, Mao

AU - Webb, John

AU - Himbert, Dominique

AU - Ruiz, Carlos E.

AU - Rodés-Cabau, Josep

AU - Pache, Gregor

AU - Colombo, Antonio

AU - Nickenig, Georg

AU - Lee, Michael

AU - Tamburino, Corrado

AU - Sievert, Horst

AU - Abramowitz, Yigal

AU - Tarantini, Giuseppe

AU - Alqoofi, Faisal

AU - Chakravarty, Tarun

AU - Kashif, Mohammad

AU - Takahashi, Nobuyuki

AU - Kazuno, Yoshio

AU - Maeno, Yoshio

AU - Kawamori, Hiroyuki

AU - Chieffo, Alaide

AU - Blanke, Philipp

AU - Dvir, Danny

AU - Ribeiro, Henrique Barbosa

AU - Feng, Yuan

AU - Zhao, Zhen Gang

AU - Sinning, Jan Malte

AU - Kliger, Chad

AU - Giustino, Gennaro

AU - Pajerski, Basia

AU - Imme, Sebastiano

AU - Grube, Eberhard

AU - Leipsic, Jonathon

AU - Vahanian, Alec

AU - Michev, Iassen

AU - Jelnin, Vladimir

AU - Latib, Azeem

AU - Cheng, Wen

AU - Makkar, Raj

N1 - Funding Information: Dr. Jilaihawi is a consultant for Edwards Lifesciences, St. Jude Medical, Venus, and Medtech. Dr. Makkar has received grants from Edwards Lifesciences; and personal fees from St. Jude Medical and Medtronic. Dr. Webb is a consultant for Edwards Lifesciences. Dr. Himbert is a consultant and proctor for Edwards Lifesciences and Medtronic. Dr. Ruiz has a financial relationship with Philips and St. Jude Medical; and has received educational grant(s) from Philips Healthcare. Dr. Sievert has received fees for consulting and travel and honoraria from Abbott, Access Closure, AGA, Angiomed, Aptus, Atrium, Avinger, Bard, Boston Scientific, Bridgepoint, Carag, Cardiac Dimensions, CardioKinetix, CardioMEMS, Cardiox, Celonova, CGuard, Coherex, Contego, Covidien, CSI, CVRx, EndoCross, ev3, FlowCardia, Gardia, Gore, Guided Delivery Systems, Hemoteq, InSeal Medical, Lumen Biomedical, HLT, Lifetech, Lutonix, Maya Medical, Medtronic, NDC, Occlutech, Osprey, Ostial, PendraCare, pfm Medical, Recor, ResMed, Rox Medical, SentreHeart, Spectranetics, SquareOne, Svelte Medical Systems, Trireme, Trivascular, Vascular Dynamics, Venus Medical, Veryan, and Vessix; owns stock options in Cardiokinetix, Access Closure, Velocimed, Lumen Biomedical, Coherex, and SMT; and has received grants from Cook and St. Jude Medical. Dr. Blanke is a consultant for Edwards Lifesciences, Neovasc, Tendyne, and Consultant Circle Imaging. Dr. Sinning has received honoraria from Medtronic, Edwards Lifesciences, Abbott, Direct Flow Medical; and has received research grants from Medtronic, Edwards Lifesciences, and Boston Scientific. Dr. Kliger has financial relationships with St. Jude Medical and Philips Healthcare. Dr. Leipsic has financial relationships with Edwards Lifesciences and Circl CVI. Dr. Vahanian has received honoraria from Abbott Vascular, Edwards Lifesciences, and Valtech. Dr. Michev is a proctor for Medtronic Corevalve and Boston Scientific. Dr. Latib is a consultant for Medtronic and Direct Flow Medical. Dr. Makkar is a consultant for Abbott Vascular, Cordis, and Medtronic; and has received grants from Edwards Lifesciences and St. Jude Medical. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. Publisher Copyright: © 2016 American College of Cardiology Foundation

PY - 2016/10/1

Y1 - 2016/10/1

N2 - Objectives This study sought to evaluate transcatheter aortic valve replacement (TAVR) in bicuspid aortic valve (BAV) aortic stenosis (AS), with a particular emphasis on TAVR-directed bicuspid aortic valve imaging (BAVi) of morphological classification. Background TAVR has been used to treat BAV-AS but with heterogeneous outcomes and uncertainty regarding the relevance of morphology. Methods In 14 centers in the United States, Canada, Europe, and Asia, 130 BAV-AS patients underwent TAVR. Baseline cardiac computed tomography (CT) was analyzed by a dedicated Corelab. Outcomes were assessed in line with Valve Academic Research Consortium criteria. Results Bicommissural BAV (vs. tricommissural) accounted for 68.9% of those treated in North America, 88.9% in Europe, and 95.5% in Asia (p = 0.003). For bicommissural bicuspids, non-raphe type (vs. raphe type) BAV accounted for 11.9% of those treated in North America, 9.4% in Europe, and 61.9% in Asia (p < 0.001). Overall rates of 30-day mortality (3.8%) and cerebrovascular events (3.2%) were favorable and similar among anatomical subsets. The rate of new permanent pacemaker insertion was high (26.2%) and similar between balloon-expandable (BE) and self-expanding (SE) designs (BE: 25.5% vs. SE: 26.9%; p = 0.83); there was a trend to greater permanent pacemaker insertion in BE TAVR in the presence of coronary cusp fusion BAV morphology. Paravalvular aortic regurgitation (PAR) ≥ moderate was 18.1% overall but lower at 11.5% in those with pre-procedural CT. In the absence of pre-procedural CT, there was an excess of PAR in BE TAVR that was not the case in those with a pre-procedural CT; SE TAVR required more post-dilation. Predictors of PAR included intercommissural distance for bicommissural bicuspids (odd ratio [OR]: 1.37; 95% confidence interval [CI]: 1.02 to 1.84; p = 0.036) and lack of a baseline CT for annular measurement (OR: 3.03; 95% CI: 1.20 to 7.69; p = 0.018). Conclusions In this multicenter study, TAVR achieved favorable outcomes in patients with pre-procedural CT, with the exception of high permanent pacemaker rates for all devices and shapes.

AB - Objectives This study sought to evaluate transcatheter aortic valve replacement (TAVR) in bicuspid aortic valve (BAV) aortic stenosis (AS), with a particular emphasis on TAVR-directed bicuspid aortic valve imaging (BAVi) of morphological classification. Background TAVR has been used to treat BAV-AS but with heterogeneous outcomes and uncertainty regarding the relevance of morphology. Methods In 14 centers in the United States, Canada, Europe, and Asia, 130 BAV-AS patients underwent TAVR. Baseline cardiac computed tomography (CT) was analyzed by a dedicated Corelab. Outcomes were assessed in line with Valve Academic Research Consortium criteria. Results Bicommissural BAV (vs. tricommissural) accounted for 68.9% of those treated in North America, 88.9% in Europe, and 95.5% in Asia (p = 0.003). For bicommissural bicuspids, non-raphe type (vs. raphe type) BAV accounted for 11.9% of those treated in North America, 9.4% in Europe, and 61.9% in Asia (p < 0.001). Overall rates of 30-day mortality (3.8%) and cerebrovascular events (3.2%) were favorable and similar among anatomical subsets. The rate of new permanent pacemaker insertion was high (26.2%) and similar between balloon-expandable (BE) and self-expanding (SE) designs (BE: 25.5% vs. SE: 26.9%; p = 0.83); there was a trend to greater permanent pacemaker insertion in BE TAVR in the presence of coronary cusp fusion BAV morphology. Paravalvular aortic regurgitation (PAR) ≥ moderate was 18.1% overall but lower at 11.5% in those with pre-procedural CT. In the absence of pre-procedural CT, there was an excess of PAR in BE TAVR that was not the case in those with a pre-procedural CT; SE TAVR required more post-dilation. Predictors of PAR included intercommissural distance for bicommissural bicuspids (odd ratio [OR]: 1.37; 95% confidence interval [CI]: 1.02 to 1.84; p = 0.036) and lack of a baseline CT for annular measurement (OR: 3.03; 95% CI: 1.20 to 7.69; p = 0.018). Conclusions In this multicenter study, TAVR achieved favorable outcomes in patients with pre-procedural CT, with the exception of high permanent pacemaker rates for all devices and shapes.

KW - TAVI

KW - TAVR

KW - aortic stenosis

KW - aortic valve replacement

KW - bicuspid aortic valve

KW - transcatheter aortic valve implantation

KW - transcatheter aortic valve replacement

UR - http://www.scopus.com/inward/record.url?scp=84978468509&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84978468509&partnerID=8YFLogxK

U2 - 10.1016/j.jcmg.2015.12.022

DO - 10.1016/j.jcmg.2015.12.022

M3 - Article

C2 - 27372022

AN - SCOPUS:84978468509

SN - 1936-878X

VL - 9

SP - 1145

EP - 1158

JO - JACC: Cardiovascular Imaging

JF - JACC: Cardiovascular Imaging

IS - 10

ER -

A Bicuspid Aortic Valve Imaging Classification for the TAVR Era

Abstract

Keywords

ASJC Scopus subject areas

Access to Document

Other files and links

Fingerprint

Cite this