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Transcatheter aortic valve replacement outcomes in bicuspid compared to trileaflet aortic valves

Session Moderated Poster 1: Interventional cardiology

Speaker Vinayak Nagaraja

Congress : Acute Cardiovascular Care 2019

  • Topic : interventional cardiology and cardiovascular surgery
  • Sub-topic : Interventional Cardiology - Other
  • Session type : Moderated Posters
  • FP Number : 31

Authors : V Nagaraja (Sydney,AU), W Suh (Los Angeles,US), DAVID Fischman (Philadelphia,US), ADRIAN Banning (Oxford,GB), SARA C Martinez (Washington,US), J Potts (Stoke-on-Trent,GB), CHUN S Kwok (Stoke-on-Trent,GB), KARIM Ratib (Stoke-on-Trent,GB), JIM Nolan (Stoke-on-Trent,GB), R Bagur (Stoke-on-Trent,GB), MAMAS Mamas (Stoke-on-Trent,GB)

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Authors:
V Nagaraja1 , W Suh2 , DAVID Fischman3 , ADRIAN Banning4 , SARA C Martinez5 , J Potts6 , CHUN S Kwok6 , KARIM Ratib6 , JIM Nolan6 , R Bagur6 , MAMAS Mamas6 , 1Prince of Wales Hospital, Cardiology - Sydney - Australia , 2University of California Los Angeles - Los Angeles - United States of America , 3Thomas Jefferson University Hospital - Philadelphia - United States of America , 4John Radcliffe Hospital - Oxford - United Kingdom , 5Providence St. Peter Hospital - Washington - United States of America , 6Keele University - Stoke-on-Trent - United Kingdom ,

Citation:

Background 
TAVR in patients with bicuspid aortic valves (BAV) is more challenging compared to individuals with trileaflet aortic valves (TAV). BAV have been excluded from the large randomized clinical trials assessing transcatheter aortic valve replacements (TAVR) and has been considered as a relative contraindication to TAVR.
Purpose
To report the outcomes of TAVR in BAV and compare them to TAV in the National Inpatient Sample (NIS). 

Methods
TAVR procedures were identified between 2011 and 2014 in the NIS dataset. Endpoints assessed included in-hospital mortality, periprocedural complications, length of stay and cost.

Results
Of 40,604 identified TAVR procedures, 407(1%) were BAV and the 40,197 (99%) were TAV. Patients with BAV were younger and had a lower comorbidity burden. In hospital mortality (4.89% vs 4.17%, OR: 1.71, 95%CI: 0.57-5.12, P=0.21), AMI (3.49% vs 3.58%, OR: 1.12, 95%CI: 0.36-3.54, P=0.85), stroke and TIA (2.49% vs 3.55%, OR: 0.75, 95%CI: 0.18-3.16, P=0.70), vascular complications (2.39% vs 5.58%, OR:0.47, 95%CI: 0.11-1.93, P=0.29), major bleeding (16.96% vs 23.50%, OR: 0.63, 95%CI: 0.34-1.17, P=0.15) and rates of  permanent pacemaker (PPM) (9.88% vs 10.88%, OR: 1.19, 95%CI: 0.57-2.51, P=0.64)  were similar in both cohorts. 

Conclusions:  With multimodality imaging and further improvement in technology, our study demonstrates off-label TAVR should not be considered prohibitive and can be successfully performed for BAV with similar peri-procedural outcomes compared to those with TAV. However, there is a need for robust large prospective studies.

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