Brain Injury after Transcatheter Aortic Valve Replacement for Bicuspid Versus Tricuspid Aortic Valve Stenosis

OBJECTIVES This study sought to evaluate the risk of brain injury in bicuspid aortic valve (BAV) patients following transcatheter aortic valve replacement (TAVR). BACKGROUND An increasing number of BAV patients are undergoing TAVR, but the risk of brain injury in diffusion-weighted magnetic resonance imaging (DW-MRI) is currently unknown. METHODS A total of 204 consecutive severe aortic stenosis patients who underwent TAVR were enrolled. 83 (40.7%) patients were BAV patients and the other 121 patients were tricuspid aortic valve (TAV) patients. All patients received DW-MRI at baseline, 2 to 7 days after TAVR. RESULTS Mean ages (mean ± SD: 75.8 ± 6.7 years vs. 78.9 ± 6.6 years, p = 0.004) and STS scores (6.0 ± 3.7 vs. 7.1 ± 4.2, p = 0.044) of the BAV and TAV patients were significantly different, while the overt stroke rates (2.4% vs. 1.7%, p = 0.704) were comparable between two groups. BAV patients were associated with higher number of new lesions (5.69 ± 6.22 vs. 3.50 ± 4.16, p = 0.008), total lesion volume [median(interquartile range): 290(70-930) mm3 vs. 140(35-480) mm3, p = 0.008], and the volume per lesion [70.0(45.0-115.0) mm3 vs. 57.5(24.5-93.0) mm3, p = 0.037] in DW-MRI. Moreover, the proportion of patients with lesions larger than 1cm3 (28.6% vs. 10.9%, p = 0.005) and the number of new lesions in the middle cerebral arteries zone (1.46 ± 2.07 vs. 0.98 ± 1.84, p = 0.039) and intermediate zone between the anterior cerebral and middle cerebral arteries (ACA/MCA) (1.07 ± 1.68 vs. 0.50 ± 1.05, p = 0.007), and between the vertebral artery and basilar artery (VA/BA) (1.01 ± 1.35 vs. 0.77 ± 1.44, p = 0.033) were higher in BAV patients than in TAV patients. CONCLUSIONS BAV patients may encounter more severe brain injuries not only due to greater number of lesions but also due to larger lesion size, especially in the ACA/MCA, MCA and VA/BA lesions zone. ### Competing Interest Statement The authors have declared no competing interest. ### Clinical Trial NCT02803294 ### Funding Statement The authors have no conflicts of interest to disclose ### Author Declarations All relevant ethical guidelines have been followed; any necessary IRB and/or ethics committee approvals have been obtained and details of the IRB/oversight body are included in the manuscript. Yes All necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines and uploaded the relevant EQUATOR Network research reporting checklist(s) and other pertinent material as supplementary files, if applicable. Yes All data referred to in the manuscript will be available after the manuscript published.