Two Consecutive Cases of Quadricuspid Aortic Valve and a Review of 149 Cases

Transcatheter Aortic Valve Replacement in Patients With Quadricuspid Aortic Valve: A Case Series and Systematic Review

Background: Quadricuspid aortic valve (QAV) is a rare congenital cardiac anomaly associated with symptomatic aortic regurgitation (AR) or aortic stenosis (AS). Transcatheter aortic valve replacement (TAVR) for QAV remains uncertain. Methods: We retrospectively reviewed prospectively collected data from patients with QAV undergoing TAVR in our center and conducted a systematic literature review for further investigation. Results: Five patients with QAV were treated with TAVR between April 2016 and December 2023. The median age was 67 years (range: 59-86), and the median Society of Thoracic Surgeons score (STS-score) was 3.750% (range: 0.916%-11.823%). Procedural success was achieved in all cases. The median follow-up period was 3 years (from 30 days to 7 years). Four of the patients exhibited no serious complications, while one experienced delayed coronary obstruction. Our systematic review included 31 cases from 21 publications and our center. The median age of patients was 79 years (range: 57-90), including 18 males. The median STS score was 7.835%. Severe AS was present in 64.5% of the patients and severe AR in 41.9%. The most common QAV subtype was type B (48.4%). Technical success was achieved in 100% of the cases, with two cases reporting coronary obstruction and one required a permanent pacemaker implantation. During a median follow-up period of 1 year (from 30 days to 7 years), one case experienced serious complications of delayed coronary obstruction. Conclusion: The TAVR may be an alternative treatment for patients with QAV, preliminarily demonstrating feasible early and long-term results from current experience. However, extra precautions regarding coronary artery obstruction complications are necessary due to the rarity and anatomical complexity of QAV.

Transcatheter aortic valve replacement in patients with quadricuspid aortic valve in a single center

Background

Quadricuspid aortic valve (QAV) is a rare congenital malformation that can present with aortic regurgitation or aortic stenosis (AS)), requiring surgical treatment. Transcatheter aortic valve replacement (TAVR) is an alternative treatment for older patients and its prognosis for QAV therapy remains challenging. We sought to examine our early experience with TAVR in patients with QAV.

Materials and methods

Prospectively collected data were retrospectively reviewed in patients with QAV undergoing TAVR in our institution.

Results

Five patients with QAV and AR or AS were treated with TAVR between January 2016 and January 2022. The mean age was 73.8 years (range 69–82 years), and the median Society of Thoracic Surgeons score was 7.51% (range 2.668–18.138%). Two patients had type B and three had either type A, D, or F according to the Hurwitz and Roberts classification for QAV. Four patients with pure aortic regurgitation underwent transapical TAVR using the J-Valve system, and the patient with severe AS underwent transfemoral TAVR using the Venus-A system. Procedural success was achieved in all five patients. Trivial paravalvular leak was only detected in one case after the procedure, and one patient received a permanent pacemaker due to high-degree atrioventricular block three days later. The median follow-up period was 18 (12–56) months. After discharge, no deaths occurred during the 1 year follow-up. All patients improved by ≥1 New York Heart Association functional class at 30 days; four patients were in functional class ≤II later in the follow-up period. All patients’ heart failure symptoms improved considerably.

Conclusion

Our early experience with TAVR in QAV demonstrates these procedures to be feasible with acceptable early results. Further follow-up is necessary to determine the long-term outcomes of this modality.

Clinical trial registration

[ClinicalTrials.gov], identifier [NCT02917980].