Transcatheter Aortic Valve Implantation in Sievers Type 0 vs. Type 1 Bicuspid Aortic Valve Morphology: Systematic Review and Meta-Analysis

Yu Du; Zhijian Wang; Wei Liu; Yonghe Guo; Wei Han; Hua Shen; Shuo Jia; Yi Yu; Kangning Han; Dongmei Shi; Yingxin Zhao; Yujie Zhou

doi:10.3389/fcvm.2021.771789

Transcatheter Aortic Valve Implantation in Sievers Type 0 vs. Type 1 Bicuspid Aortic Valve Morphology: Systematic Review and Meta-Analysis

Front Cardiovasc Med. 2021 Nov 5:8:771789. doi: 10.3389/fcvm.2021.771789. eCollection 2021.

Authors

Yu Du¹, Zhijian Wang¹, Wei Liu¹, Yonghe Guo¹, Wei Han¹, Hua Shen¹, Shuo Jia¹, Yi Yu¹, Kangning Han¹, Dongmei Shi¹, Yingxin Zhao¹, Yujie Zhou¹

Affiliation

¹ Beijing Key Laboratory of Precision Medicine of Coronary Atherosclerotic Disease, Department of Cardiology, Clinical Center for Coronary Heart Disease, Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.

Abstract

Background: Transcatheter aortic valve implantation (TAVI) has achieved satisfactory outcomes in the selected patients with bicuspid aortic valve (BAV), predominately type 1 BAV (~90%). However, there are few reports about the safety and efficacy of TAVI in type 0 BAV. Therefore, in the current study, we aimed to compare procedural and 30-day outcomes after TAVI between type 0 and type 1 BAV. Methods: Studies comparing the outcomes of TAVI in Sievers type 0 vs. type 1 BAV were retrieved from PubMed, EMBASE, Cochrane Library, and Web of Science from inception to May 2021. The data were extracted regarding the study characteristics and outcomes. The odds ratios (ORs) with 95% CIs were pooled for procedural and 30-day outcomes. Results: Six observational studies were included with determined type 0 BAV in 226 patients and type 1 BAV in 902 patients. The patients with type 0 BAV were slightly younger, had larger supra-annular structure, and more frequently implanted self-expanding prosthesis compared with type 1 BAV. In the pooled analyses, the patients with type 0 BAV had a similar incidence of procedural death (OR = 2.6, 95% CI 0.7-10.3), device success (OR = 0.6; 95% CI 0.3-1.3), and ≥ mild (OR = 0.8; 95% CI 0.4-1.6) or moderate (OR = 0.9, 95% CI 0.4-1.8) paravalvular leak, whereas significantly higher mean aortic gradient (mean difference = 1.4 mmHg, 95% CI 0.03-2.7) and increased coronary compromise risk (OR = 7.2; 95% CI 1.5-34.9), compared with type 1 BAV. Meanwhile, the incidence of death (OR = 1.2; 95% CI 0.5-3.1), stroke (OR = 0.5; 95% CI 0.1-2.4), and new pacemaker (OR = 0.6; 95% CI 0.2-2.2) at 30 days were not significantly different between the BAV morphologies (p > 0.05). The treatment effect heterogeneity across the studies for the above outcomes were low. Conclusions: The patients with type 0 BAV appear to have similar short-term outcomes after TAVI compared with type 1 BAV. Whereas, TAVI for type 0 BAV aortic stenosis might lead to an elevated coronary obstruction risk and suboptimal aortic valvular hemodynamics.

Keywords: Sievers type 0; bicuspid aortic valve; meta-analysis; outcomes; transcatheter aortic valve implantation.

Publication types

Systematic Review