Comparison between severe R-L and R-NC raphe-type bicuspid aortic valve stenosis treated with TAVI: insights from the international AD HOC Registry.

Vicere, A.; Kim, WK.; Zito, A.; Fabris, T.; De Biase, C.; Restivo, A.; Montarello, N.; Costa, G.; Colucci, M.; Koren, O.; Fezzi, S.; Bellini, B.; Massussi, M.; Scotti, A.; Galasso, M.; Mazzapicchi, A.; Giacomin, E.; Gorla, R.; Rheude, T.; Bellamoli, M.; Briguori, C.; Leone, PP.; Villa, E.; Casamassima, F.; Aurigemma, C.; Renker, M.; Gomez, MG.; Benvenuto, CP.; Leone, AM.; Laterra, G.; Gitto, M.; Cattaneo, G.; Romagnoli, E.; Esposito, G.; Ielasi, A.; Orbach, A.; Brambilla, N.; Amat-Santos, I.; Mangieri, A.; Saia, F.; Favero, L.; Chen, M.; Adamo, M.; Latib, A.; De Carlo, M.; Montorfano, M.; Makkar, RR.; Mylotte, D.; Blackman, DJ.; Trani, C.; Burzotta, F.; Barbanti, M.; De Backer, O.; Tchetche, D.; Maffeo, D.; Tarantini, G.; Buono, A.

Comparison between severe R-L and R-NC raphe-type bicuspid aortic valve stenosis treated with TAVI: insights from the international AD HOC Registry.

All Authors

Vicere, A.

Kim, WK.

Zito, A.

Fabris, T.

De Biase, C.

Restivo, A.

Montarello, N.

Costa, G.

Colucci, M.

Koren, O.

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LTHT Author

Blackman, Daniel

LTHT Department

Cardio-Respiratory
Cardiology

Publication Date

2025

Item Type

Journal Article

Abstract

BACKGROUND: Sievers type 1 bicuspid aortic valve (BAV) stenosis presents unique challenges for trans-catheter aortic valve implantation (TAVI), particularly when calcified raphe is present. The impact of raphe localization on TAVI outcomes remains unclear. OBJECTIVES: This study aimed to compare procedural and clinical outcomes in patients with right-left (R-L) and right-non coronary (R-NC) raphe-type BAV treated with TAVI. METHODS: Between January 2016 and October 2023, 956 consecutive patients with severe Sievers type 1 BAV stenosis underwent trans-femoral (TF)-TAVI across 24 tertiary centers. Pre-procedural computed tomography was retrospectively analyzed. To address the non-randomized study's design, 2:1 propensity score matching (PSM) was performed between R-L and R-NC groups. Primary endpoints included VARC-3 technical success, 30-day device success, early safety, and mid-term major adverse events (death, stroke, or heart failure hospitalization at the last follow-up). RESULTS: 825 had R-L raphe whereas 131 had R-NC pattern. After PSM, 251 R-L and 128 R-NC were analyzed. Baseline clinical, electrocardiographic, echocardiographic, computed tomography and procedural features were similar. Technical success was high in both groups (92.8 % vs 96.1 %; OR 0.53; 95%CI 0.19-1.45; p = 0.215), with comparable short- and mid-term outcomes. However, permanent pacemaker implantation (PPI) incidence was 3 times higher in R-L compared to R-NC (16.1 % vs. 6.7 %; OR 0.37, CI 0.16-0.89). CONCLUSIONS: Raphe localization in Sievers type 1 BAV does not affect major TAVI outcomes except for PPI risk, which is 3-fold higher in R-L patients.