Imaging, Treatment Options, Patient Selection, and Outcome Considerations for Patients With Bicuspid Aortic Valve Disease

Overview

Journal J Soc Cardiovasc Angiogr Interv

Specialty Cardiology & Vascular Diseases

Date 2024 Aug 12

PMID 39132366

Authors

Yousif Ahmad

Vratika Agarwal

Matthew L Williams

Dee Dee Wang

Michael J Reardon

Joao L Cavalcante

Raj Makkar

John K Forrest

Affiliations

Soon will be listed here.

Abstract

Transcatheter aortic valve replacement has emerged as a safe and effective alternative to surgical aortic valve replacement for patients with severe symptomatic aortic stenosis across the spectrum of surgical risks based on a series of foundational randomized clinical trials. Of note, patients with bicuspid aortic valve (BAV) disease were excluded from all these pivotal randomized trials, leaving a significant knowledge gap because BAVs are commonly encountered in patients referred for aortic valve surgery or intervention. In this comprehensive review, we aim to provide heart teams with a detailed insight into how to approach patients with BAV disease, focusing on imaging and characterization of bicuspid valves, an overview of surgical approaches, and an understanding of the current data behind the role of transcatheter aortic valve replacement for patients with BAV disease.

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References

Bourguignon T, El Khoury R, Candolfi P, Loardi C, Mirza A, Boulanger-Lothion J . Very Long-Term Outcomes of the Carpentier-Edwards Perimount Aortic Valve in Patients Aged 60 or Younger. Ann Thorac Surg. 2015; 100(3):853-9. DOI: 10.1016/j.athoracsur.2015.03.105. View

He Y, Fan J, Zhu Q, Zhou Q, Jiang J, Wang L . Ascending aortic dilatation rate after transcatheter aortic valve replacement in patients with bicuspid and tricuspid aortic stenosis: A multidetector computed tomography follow-up study. World J Emerg Med. 2019; 10(4):197-204. PMC: 6732170. DOI: 10.5847/wjem.j.1920-8642.2019.04.001. View

Clavel M, Pibarot P, Messika-Zeitoun D, Capoulade R, Malouf J, Aggarval S . Impact of aortic valve calcification, as measured by MDCT, on survival in patients with aortic stenosis: results of an international registry study. J Am Coll Cardiol. 2014; 64(12):1202-13. PMC: 4391203. DOI: 10.1016/j.jacc.2014.05.066. View

Kong W, Delgado V, Poh K, Regeer M, Ng A, McCormack L . Prognostic Implications of Raphe in Bicuspid Aortic Valve Anatomy. JAMA Cardiol. 2017; 2(3):285-292. DOI: 10.1001/jamacardio.2016.5228. View

Masri A, Kalahasti V, Alkharabsheh S, Svensson L, Sabik J, Roselli E . Characteristics and long-term outcomes of contemporary patients with bicuspid aortic valves. J Thorac Cardiovasc Surg. 2016; 151(6):1650-1659.e1. DOI: 10.1016/j.jtcvs.2015.12.019. View

Borger M, Preston M, Ivanov J, Fedak P, Davierwala P, Armstrong S . Should the ascending aorta be replaced more frequently in patients with bicuspid aortic valve disease?. J Thorac Cardiovasc Surg. 2004; 128(5):677-83. DOI: 10.1016/j.jtcvs.2004.07.009. View

Philip F, Faza N, Schoenhagen P, Desai M, Tuzcu E, Svensson L . Aortic annulus and root characteristics in severe aortic stenosis due to bicuspid aortic valve and tricuspid aortic valves: implications for transcatheter aortic valve therapies. Catheter Cardiovasc Interv. 2015; 86(2):E88-98. DOI: 10.1002/ccd.25948. View

Mylotte D, Lefevre T, Sondergaard L, Watanabe Y, Modine T, Dvir D . Transcatheter aortic valve replacement in bicuspid aortic valve disease. J Am Coll Cardiol. 2014; 64(22):2330-9. DOI: 10.1016/j.jacc.2014.09.039. View

Deeb G, Reardon M, Ramlawi B, Yakubov S, Chetcuti S, Kleiman N . Propensity-Matched 1-Year Outcomes Following Transcatheter Aortic Valve Replacement in Low-Risk Bicuspid and Tricuspid Patients. JACC Cardiovasc Interv. 2022; 15(5):511-522. DOI: 10.1016/j.jcin.2021.10.027. View

10.

Carroll J, Mack M, Vemulapalli S, Herrmann H, Gleason T, Hanzel G . STS-ACC TVT Registry of Transcatheter Aortic Valve Replacement. J Am Coll Cardiol. 2020; 76(21):2492-2516. DOI: 10.1016/j.jacc.2020.09.595. View

11.

Yoon S, Bleiziffer S, De Backer O, Delgado V, Arai T, Ziegelmueller J . Outcomes in Transcatheter Aortic Valve Replacement for Bicuspid Versus Tricuspid Aortic Valve Stenosis. J Am Coll Cardiol. 2017; 69(21):2579-2589. DOI: 10.1016/j.jacc.2017.03.017. View

12.

Thourani V, Brennan J, James Edelman J, Thibault D, Jawitz O, Bavaria J . Association of Volume and Outcomes in 234 556 Patients Undergoing Surgical Aortic Valve Replacement. Ann Thorac Surg. 2021; 114(4):1299-1306. DOI: 10.1016/j.athoracsur.2021.06.095. View

13.

Borger M, Fedak P, Stephens E, Gleason T, Girdauskas E, Ikonomidis J . The American Association for Thoracic Surgery consensus guidelines on bicuspid aortic valve-related aortopathy: Full online-only version. J Thorac Cardiovasc Surg. 2018; 156(2):e41-e74. PMC: 6413866. DOI: 10.1016/j.jtcvs.2018.02.115. View

14.

Leon M, Smith C, Mack M, Miller D, Moses J, Svensson L . Transcatheter aortic-valve implantation for aortic stenosis in patients who cannot undergo surgery. N Engl J Med. 2010; 363(17):1597-607. DOI: 10.1056/NEJMoa1008232. View

15.

HARKEN D, SOROFF H, Taylor W, LEFEMINE A, Gupta S, LUNZER S . Partial and complete prostheses in aortic insufficiency. J Thorac Cardiovasc Surg. 1960; 40:744-62. View

16.

Mack M, Leon M, Thourani V, Makkar R, Kodali S, Russo M . Transcatheter Aortic-Valve Replacement with a Balloon-Expandable Valve in Low-Risk Patients. N Engl J Med. 2019; 380(18):1695-1705. DOI: 10.1056/NEJMoa1814052. View

17.

Elbadawi A, Saad M, Elgendy I, Barssoum K, Omer M, Soliman A . Temporal Trends and Outcomes of Transcatheter Versus Surgical Aortic Valve Replacement for Bicuspid Aortic Valve Stenosis. JACC Cardiovasc Interv. 2019; 12(18):1811-1822. DOI: 10.1016/j.jcin.2019.06.037. View

18.

Shen M, Tastet L, Capoulade R, Arsenault M, Bedard E, Clavel M . Effect of bicuspid aortic valve phenotype on progression of aortic stenosis. Eur Heart J Cardiovasc Imaging. 2020; 21(7):727-734. PMC: 7306858. DOI: 10.1093/ehjci/jeaa068. View

19.

Makkar R, Yoon S, Leon M, Chakravarty T, Rinaldi M, Shah P . Association Between Transcatheter Aortic Valve Replacement for Bicuspid vs Tricuspid Aortic Stenosis and Mortality or Stroke. JAMA. 2019; 321(22):2193-2202. PMC: 6563564. DOI: 10.1001/jama.2019.7108. View

20.

Puskas J, Bavaria J, Svensson L, Blackstone E, Griffith B, Gammie J . The COMMENCE trial: 2-year outcomes with an aortic bioprosthesis with RESILIA tissue. Eur J Cardiothorac Surg. 2017; 52(3):432-439. DOI: 10.1093/ejcts/ezx158. View