Transcatheter aortic valve replacement in patients with bicuspid aortic valve stenosis: national trends and in-hospital outcomes

Abstract

Background: Bicuspid aortic valve (BAV) disease is considered the most common congenital heart disease and the main etiology of aortic valve stenosis (AS) in young adults. Although transcatheter aortic valve replacement (TAVR) is routinely used in high- and intermediate-risk patients with AS, BAV patients with AS were excluded from all pivotal trials that led to TAVR approval. We sought, therefore, to examine in-hospital outcomes of patients with BAV who underwent TAVR in comparison with surgical aortic valve replacement (SAVR). Methods: Using the National Inpatient Sample from 2011 to 2014, we identified patients with BAV with International Classification of Diseases-Ninth Revision-CM code 746.4. Patients who underwent TAVR were identified using ICD-9 codes 35.05 and 35.06 and those who underwent SAVR were identified using codes 35.21 and 35.22 during the same period. Results: A total of 37,052 patients were found to have BAV stenosis. Among them, 36,629 patients (98.8%) underwent SAVR, whereas 423 patients (1.14%) underwent TAVR. One-third of enrolled patients were female, and the majority of the patients were White with a mean age of 65.9 ± 15.1 years. TAVR use for BAV stenosis significantly increased from 0.39% in 2011 to 4.16% in 2014 (P < 0.001), which represents a 3.77% overall growth in procedure rate. The median length of stay decreased significantly throughout the study period (mean 12.2 ± 8.2 days to 7.1 ± 5.9 days, P < 0.001). There was no statistically significant difference between SAVR and TAVR groups in the in-hospital mortality (0% vs. 5.9%; adjusted P = 0.119). Conclusion: There is a steady increase in TAVR use for BAV stenosis patients along with a significant decrease in length of stay.

Keywords

Bicuspid aortic valve stenosis - surgical aortic valve replacement - transcatheter aortic valve replacement

Publication History

Article published online:
04 August 2021

• References

• 1 Michelena HI, Prakash SK, Della Corte A, Bissell MM, Anavekar N, Mathieu P. et al. Bicuspid aortic valve: identifying knowledge gaps and rising to the challenge from the international bicuspid aortic valve consortium (BAVCon). Circulation 2014; 129: 2691-704
• 2 Leon MB, Smith CR, Mack M, Miller DC, Moses JW, Svensson LG. et al. Transcatheter aortic-valve implantation for aortic stenosis in patients who cannot undergo surgery. N Engl J Med 2010; 363: 1597-607
• 3 Smith CR, Leon MB, Mack MJ, Miller DC, Moses JW, Svensson LG. et al. Transcatheter versus surgical aortic-valve replacement in high-risk patients. N Engl J Med 2011; 364: 2187-98
• 4 Reardon MJ, Van Mieghem NM, Popma JJ, Kleiman NS, Søndergaard L, Mumtaz M. et al. Surgical or transcatheter aortic-valve replacement in intermediate-risk patients. N Engl J Med 2017; 376: 1321-31
• 5 Leon MB, Smith CR, Mack MJ, Makkar RR, Svensson LG, Kodali SK. et al. Transcatheter or surgical aortic-valve replacement in intermediate-risk patients. N Engl J Med 2016; 374: 1609-20
• 6 Adams DH, Popma JJ, Reardon MJ, Yakubov SJ, Coselli JS, Deeb GM. et al. Transcatheter aortic-valve replacement with a self-expanding prosthesis. N Engl J Med 2014; 370: 1790-8
• 7 Leon MB, Smith CR, Mack M, Miller DC, Moses JW, Svensson LG. et al. Transcatheter aortic-valve implantation for aortic stenosis in patients who cannot undergo surgery. N Engl J Med 2010; 363: 1597-607
• 8 Popma JJ, Adams DH, Reardon MJ, Yakubov SJ, Kleiman NS, Heimansohn D. et al. Transcatheter aortic valve replacement using a self-expanding bioprosthesis in patients with severe aortic stenosis at extreme risk for surgery. J Am Coll Cardiol 2014; 63: 1972-81
• 9 Nishimura RA, Otto CM, Bonow RO, Carabello BA, Erwin III JP, Guyton RA. et al. 2014 AHA/ACC guideline for the management of patients with valvular heart disease. J Thor Cardiovas Surg 2014; 148: e1-e132
• 10 Hira RS, Vemulapalli S, Li Z, McCabe JM, Rumsfeld JS, Kapadia SR. et al. Trends and outcomes of off-label use of transcatheter aortic valve replacement: insights from the NCDR STS/ACC TVT registry. JAMA Cardiol 2017; 2: 846-54
• 11 Overview of the National (Nationwide) Inpatient Sample (NIS). Available from: https://www.hcup-us.ahrq.gov/nisoverview.jsp. [Last accessed on 2018 Feb]
• 12 Elixhauser A, Steiner C, Harris DR, Coffey RM. Comorbidity measures for use with administrative data. Med Care 1998; 36: 8-27
• 13 Kappetein AP, Head SJ, Généreux P, Piazza N, van Mieghem NM, Blackstone EH. Updated standardized endpoint definitions for transcatheter aortic valve implantation: the valve academic research consortium-2 consensus document. Eur Heart J 2012; 33: 2403-18
• 14 Wijesinghe N, Ye J, Rodés-Cabau J, Cheung A, Velianou JL, Natarajan MK. et al. Transcatheter aortic valve implantation in patients with bicuspid aortic valve stenosis. JACC Cardiovasc Interv 2010; 3: 1122-5
• 15 Mylotte D, Lefevre T, Søndergaard L, Watanabe Y, Modine T, Dvir D. et al. Transcatheter aortic valve replacement in bicuspid aortic valve disease. J Am Coll Cardiol 2014; 64: 2330-9
• 16 Perlman GY, Blanke P, Dvir D, Pache G, Modine T, Barbanti M. et al. Bicuspid aortic valve stenosis: favorable early outcomes with a next-generation transcatheter heart valve in a multicenter study. JACC Cardiovasc Interv 2016; 9: 817-24
• 17 Yoon SH, Lefèvre T, Ahn JM, Perlman GY, Dvir D, Latib A. et al. Transcatheter aortic valve replacement with early- and new-generation devices in bicuspid aortic valve stenosis. J Am Coll Cardiol 2016; 68: 1195-205
• 18 Makkar RR, Yoon SH, Leon MB, Chakravarty T, Rinaldi M, Shah PB. et al. Association between transcatheter aortic valve replacement for bicuspid vs tricuspid aortic stenosis and mortality or stroke. JAMA 2019; 321: 2193-202
• 19 Ando T, Adegbala O, Akintoye E, Ashraf S, Pahuja M, Briasoulis A. Is transcatheter aortic valve replacement better than surgical aortic valve replacement in patients with chronic obstructive pulmonary disease? a nationwide inpatient sample analysis. J Am Heart Assoc 2018; 7: pii, e008408