Assess the Outcomes of Transcatheter Aortic Valve Replacement in Bicuspid Valve with Mixed Disease versus Predominant Aortic Stenosis

Figures & data

Table 1 Demographic and Computed Tomography Characteristics of the Study Populations

Variables	Total(N=262)	MAVD(N=83)	PAS(N=179)	P value
Age	72(67,75)	71(67,75)	72(67,75)	0.876
Male	146(55.7)	51(61.4)	95(53.1)	0.204
Hypertension	115(43.9)	34(41.0)	81(45.3)	0.515
Diabetes mellitus	58(22.1)	14(16.9)	44(24.6)	0.162
CAD	71(27.1)	20(24.1)	51(28.5)	0.456
Prior PCI	40(15.3)	9(10.8)	31(17.3)	0.175
Prior CABG	0	0	0	–
Prior AF	29(11.1)	7(8.4)	22(12.3)	0.355
Prior Stroke	14(5.3)	6(7.2)	8(4.5)	0.383
PAD	23(8.8)	6(7.2)	17(9.5)	0.564
CKD	71(27.1)	20(24.1)	51(28.5)	0.456
History of malignancy	20(7.6)	4(4.8)	16(8.9)	0.243
NYHA>II	146(55.7)	49(59.0)	97(54.2)	0.463
STS score, %	2.03(1.38,3.27)	2.04(1.44,3.16)	1.97(1.31,3.92)	0.909
Pre-procedure CT
LVOT calcification	50(19.1)	16(19.3)	34(19.0)	0.957
Severe calcification	100(38.2)	40(48.2)	60(33.5)	0.023
Annulus Area, mm^2	381(89,484)	430(191,550)	371(79,463)	0.008
LVOT area, mm^2	320(22,468)	368(24,561)	307(22,433)	0.001
Aortic Root Angle,°	42(16,55)	42(15,56)	41(16,55)	0.909
NC calcification, mm^3	344(121,672)	371(168,734)	313(113,668)	0.258
RC calcification, mm^3	199(69,377)	255(100,419)	188(53,343.5)	0.101
LC calcification, mm^3	158(57,360)	156(74,365)	161(50,359)	0.559

Note: Data are presented as mean ± standard deviation, median (interquartile range), or n (%).

Abbreviations: CAD, Coronary artery disease; PCI, percutaneous coronary intervention; AF, Atrial fibrillation; PAD, peripheral artery disease; CKD, Chronic kidney disease; LVEF, left ventricular ejection fraction; NYHA, New York Heart Association Functional classification; STS score, the Society of Thoracic Surgery risk score; LVOT, left ventricular outflow tract; NC, non-coronary cusp; RC, right coronary cusp; LC, left coronary cusp.

Table 2 Echocardiographic Characteristics of the Populations

	MAVD(N=83)	PAS(N=179)	P value
Pre-procedure
Mean aortic valve gradient, mm Hg	58(43,72)	61(52,76)	0.067
Peak velocity, m/s	5(4.4,5.6)	5(4.6,5.5)	0.354
Tricuspid regurgitation > mild, n (%)	27(32.5)	36(20.1)	0.029
Mitral regurgitation > mild, n (%)	44(53.0)	52(29.1)	<0.001
Pulmonary hypertension > mild, n (%)	27(32.5)	32(17.9)	0.008
LVEF, %	48(35,62)	62(49,68)	<0.001
Post-procedure
Tricuspid regurgitation > mild, n (%)	11(13.3)	33(18.4)	0.296
Mitral regurgitation > mild, n (%)	18(21.7)	36(20.1)	0.769
Pulmonary hypertension > mild, n (%)	5(6.0)	11(6.1)	0.97
LVEF, %	56(42,62)	64(56,67)	<0.001
PVL, n (%)	58(69.9)	113(63.1)	0.286

Note: Data are presented as mean ± standard deviation, median (interquartile range), or n (%).

Abbreviations: LVEF, left ventricular ejection fraction; PVL, Paravalvular leak.

Table 3 Procedure Details of Transcatheter Aortic Valve Replacement

	MAVD(N=83)	PAS(N=179)	P value
Combined with PCI, n (%)	4(4.8)	12(6.7)	0.553
Transfemoral access, n (%)	79(95.2)	167(93.3)	0.553
Pre-dilatation, n (%)	82(98.8)	178(99.4)	0.534
Post-dilatation, n (%)	48(57.8)	91(50.8)	0.291
Valve type			0.442
SE	82(98.8)	172(96.1)
BE	1(1.2)	7(3.9)
Valve size			<0.001
20–24mm	18(21.7)	75(41.9)
25–27mm	32(38.6)	83(46.4)
29–32mm	33(39.8)	21(11.7)
TAV-in-TAV, n (%)	11(13.3)	11(6.1)	0.054

Note: Data are presented as mean ± standard deviation, median (interquartile range), or n (%).

Abbreviations: SE, self-expandable prosthesis; BE, balloon-expandable prosthesis.

Table 4 Clinical Outcomes According to MAVD and PAS in Unmatched Population

	Total(N=262)	MAVD(N=83)	PAS(N=179)	P value
Device success	201(76.7)	58(69.9)	143(79.9)	0.075
Technical success	223(85.1)	69(83.1)	154(86.0)	0.539
In-hospital mortality	5(1.9)	1(1.2)	4(2.2)	1
Stroke	5(1.9)	3(3.6)	2(1.1)	0.33
Bleeding (type2-4)	19(7.3)	5(6.0)	14(7.8)	0.602
Major vascular complication	18(6.9)	3(3.6)	15(8.4)	0.156
Acute kidney injury (stage 2-4)	10(3.8)	6(7.2)	4(2.2)	0.078
Pacemaker implantation	11(4.2)	6(7.2)	5(2.8)	0.108
Periprocedural mortality	9(3.4)	3(3.6)	6(3.4)	1

Note: Data are presented as n (%).

Table 5 Clinical Outcomes According to MAVD and PAS in Matched Population

	Total(N=132)	MAVD(N=66)	PAS(N=66)	P value
Device success	100(75.8)	52(78.8)	48(72.7)	0.417
Technical success	112(84.8)	59(89.4)	53(80.3)	0.145
In-hospital mortality	3(2.3)	0	3(4.5)	0.244
Stroke	4(3.0)	3(4.5)	1(1.5)	0.619
Bleeding (type 2-4)	10(7.6)	2(3.0)	8(12.1)	0.048
Major vascular complication	6(4.5)	1(1.5)	5(7.6)	0.208
Acute kidney injury (stage 2-4)	8(6.1)	6(9.1)	2(3.0)	0.274
Pacemaker implantation	7(5.3)	5(7.6)	2(3.0)	0.44
Periprocedural mortality	7(5.3)	2(3.0)	5(7.6)	0.44

Note: Data are presented as n (%).

Figure 1 48 months survival in MAVD and PAS patients. (A) 48 months survival in the whole cohort; (B) 48 months survival in the propensity score matches cohort.