Our Summary

This research paper studies the use of a heart procedure called Transcatheter Aortic Valve Replacements (TAVR) in patients with a condition known as Bicuspid Aortic Valve (BAV) stenosis. BAV is a heart condition where the aortic valve has only two leaflets, instead of the normal three. Stenosis is a condition where the valve becomes narrow, restricting blood flow.

Traditionally, patients with BAV have not been included in large clinical trials for TAVR. However, improvements in technology, the introduction of new devices, and better results have led to an increase in the use of TAVR worldwide, including in patients with BAV stenosis.

The study reviewed data from 11 large studies involving about 1300 patients with BAV stenosis to see how safe and effective TAVR is for these patients. They found that TAVR may be a safe and feasible treatment for patients with BAV stenosis, especially when using newer devices.

However, the study also found that there were higher rates of complications with the procedure when using older devices. The outcomes after the procedure were the same regardless if the patients had BAV or the normal three-leaflet aortic valve (tricuspid).

The researchers conclude that larger studies need to be done to see how long-term and durable the results of TAVR are in patients with BAV.

FAQs

  1. What is a bicuspid aortic valve and how is it related to transcatheter aortic valve replacements?
  2. What outcomes have been observed in patients with BAV stenosis who have undergone TAVR?
  3. Are there differences in outcomes between the use of early generation TAVR devices and new generation devices in BAV stenosis patients?

Doctor’s Tip

A doctor might tell a patient considering aortic valve replacement that TAVR (transcatheter aortic valve replacement) is a safe and feasible treatment option for those with bicuspid aortic valve stenosis. New generation devices have shown high success rates, but it is important to be aware of potential adverse procedural events, especially with early generation devices. It is recommended to discuss the long-term outcomes and durability of TAVR with your healthcare provider before making a decision.

Suitable For

Patients with bicuspid aortic valve (BAV) stenosis who are at high risk for traditional surgical aortic valve replacement are typically recommended for transcatheter aortic valve replacement (TAVR). This includes elderly patients, patients with multiple comorbidities, or patients who are not suitable candidates for open-heart surgery. TAVR may also be considered for patients with BAV who have a low surgical risk but prefer a less invasive treatment option. Additionally, TAVR may be recommended for patients with BAV who have previously undergone surgical aortic valve replacement and are experiencing valve failure or complications.

Timeline

  • Patient is diagnosed with bicuspid aortic valve stenosis
  • Patient undergoes evaluation for transcatheter aortic valve replacement (TAVR)
  • TAVR procedure is performed using new generation devices
  • Patient experiences successful TAVR with high device success rate
  • Patient is monitored for adverse procedural events post-procedure
  • Patient shows no differences in post-procedural outcomes compared to patients with tricuspid aortic anatomy
  • Larger studies are needed to evaluate long-term outcome and durability of TAVR in patients with bicuspid aortic valve

What to Ask Your Doctor

  1. What are the potential risks and complications associated with aortic valve replacement surgery?
  2. What is the success rate of the procedure in patients with bicuspid aortic valve stenosis?
  3. How long is the recovery period after the surgery?
  4. Will I need to take medications after the procedure, and if so, for how long?
  5. Will I require any follow-up tests or appointments after the surgery?
  6. Are there any lifestyle changes I should make to improve the outcome of the surgery?
  7. How long can I expect the new valve to last?
  8. Are there any restrictions on physical activity or diet after the surgery?
  9. What should I do if I experience any symptoms or complications after the surgery?
  10. Are there any alternative treatment options available for my condition?

Reference

Authors: Patel SV, Sonani R, Singh V, Patel P, Badheka A. Journal: Expert Rev Pharmacoecon Outcomes Res. 2017 Dec;17(6):579-585. doi: 10.1080/14737167.2017.1391692. Epub 2017 Oct 16. PMID: 29017405