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Cuko B, Baudo M, Busuttil O, Taymoor S, Nubret K, Lafitte S, Beurton A, Ouattara A, De Vincentiis C, Labrousse L, Pernot M, Leroux L, Modine T. Transcatheter valvular interventions after heart transplantation: A systematic review. Trends Cardiovasc Med 2024; 34:362-368. [PMID: 37951484 DOI: 10.1016/j.tcm.2023.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 10/24/2023] [Accepted: 10/31/2023] [Indexed: 11/14/2023]
Abstract
An increasing number of patients experience late valvular disease after heart transplantation (HTx). While mostly being primarily addressed through surgical interventions, transcatheter valve procedures to treat these conditions are rising, particularly for unsuitable surgical candidates. This review aims at analyzing the outcomes of transcatheter valvular procedures in this subset of patients. A systematic review was conducted including studies reporting on adult patients requiring any form of transcatheter valvular intervention after a previous HTx. Studies involving a surgical approach, heterotopic heart transplants, or concomitant procedures performed during the transplant itself were excluded. Twenty-five articles with a total of 33 patients met the inclusion criteria, 10 regarding the aortic valve (14 patients), 5 the mitral valve (6 patients), and 6 the tricuspid valve (13 patients). In two cases, the procedure was recommended to stabilize the valvular lesion before re-transplantation, as both were very young patients. Overall, the mean time from heart transplantation to reintervention was 14.7 ± 9.5 years. The mean follow-up was 15.5 ± 13.5 months, and only one patient died 22.3 months after the intervention. There is a growing emergence of transcatheter interventions for valvular disease after heart transplantation, especially in cases where surgery is deemed high-risk or prohibitive. A different strategy may also be considered in young patients to permit longer allograft life before later re-transplantation. Although encouraging outcomes have been documented, additional research is required to establish the most appropriate approach within this specific subset of patients.
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Affiliation(s)
- Besart Cuko
- Department of Cardiology and Cardio-Vascular Surgery, Hopital Cardiologique de Haut-Leveque, Bordeaux University Hospital, Pessac, France.
| | - Massimo Baudo
- Department of Cardiac Surgery, ASST Spedali Civili di Brescia, University of Brescia, Brescia, Italy; Department of Cardiac Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Olivier Busuttil
- Department of Cardiology and Cardio-Vascular Surgery, Hopital Cardiologique de Haut-Leveque, Bordeaux University Hospital, Pessac, France
| | - Saud Taymoor
- Department of Cardiology and Cardio-Vascular Surgery, Hopital Cardiologique de Haut-Leveque, Bordeaux University Hospital, Pessac, France
| | - Karine Nubret
- Department of Cardiology and Cardio-Vascular Surgery, Hopital Cardiologique de Haut-Leveque, Bordeaux University Hospital, Pessac, France
| | - Stephane Lafitte
- Department of Cardiology and Cardio-Vascular Surgery, Hopital Cardiologique de Haut-Leveque, Bordeaux University Hospital, Pessac, France
| | - Antoine Beurton
- Department of Cardiovascular Anesthesia and Critical Care, Hopital Cardiologique de Haut-Leveque, Bordeaux University Hospital, Pessac, France
| | - Alexandre Ouattara
- Department of Cardiovascular Anesthesia and Critical Care, Hopital Cardiologique de Haut-Leveque, Bordeaux University Hospital, Pessac, France
| | | | - Louis Labrousse
- Department of Cardiology and Cardio-Vascular Surgery, Hopital Cardiologique de Haut-Leveque, Bordeaux University Hospital, Pessac, France
| | - Mathieu Pernot
- Department of Cardiology and Cardio-Vascular Surgery, Hopital Cardiologique de Haut-Leveque, Bordeaux University Hospital, Pessac, France
| | - Lionel Leroux
- Department of Cardiology and Cardio-Vascular Surgery, Hopital Cardiologique de Haut-Leveque, Bordeaux University Hospital, Pessac, France
| | - Thomas Modine
- Department of Cardiology and Cardio-Vascular Surgery, Hopital Cardiologique de Haut-Leveque, Bordeaux University Hospital, Pessac, France
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Yilmaz O, Keenan NM. Management options of valvular heart diseases after heart transplantation: A scoping review. TURK GOGUS KALP DAMAR CERRAHISI DERGISI 2024; 32:112-122. [PMID: 38545365 PMCID: PMC10964309 DOI: 10.5606/tgkdc.dergisi.2024.25631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 01/07/2024] [Indexed: 01/31/2025]
Abstract
Background This study aimed to outline the valvular changes following heart transplantation and describe the management options to address these conditions. Methods A literature search using EMBASE, MEDLINE, and PubMed databases was performed in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines in this study. Clinical studies involving patients who had their first heart transplant and articles that mentioned management for valvular heart disease were included. Treatment options were grouped into four categories: cardiac surgery other than retransplant and valve surgery, valve replacement and repairs, nonsurgical interventions, and conservative management. Results Nine hundred and three (6.56%) patients out of 13,757 patients (10,529 males, 3,228 females; mean age: 60.3±10.4 years; range, 20 to 83 years) undergoing heart transplantation were identified with valvular disease affecting one or more valves. The mean interval between the transplant and the diagnosis of valve disease was 11.31±6.95 years. The most common valvular heart disease was tricuspid regurgitation, with 796 (94.09%) occurrences, followed by mitral regurgitation (n=22, 2.6%), aortic regurgitation (n=14, 1.65%), aortic stenosis (n=11, 1.3%), and mitral stenosis (n=3, 0.35%). Additionally, the number of surgical valve replacement and repairs (n=89) was higher than nonsurgical interventions (n=20). Conclusion Acquired valvular heart diseases after cardiac transplantation are an infrequent clinical presentation that can cause valvular changes in the recipient. According to the extracted data, there is no sole superior management option, and more research is needed in this area.
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Affiliation(s)
- Ogulcan Yilmaz
- Department of Anatomy, University of Limerick, School of Medicine, Limerick, Ireland
| | - Niamh M. Keenan
- Department of Surgical Affairs, Royal College of Surgeons in Ireland, Dublin, Ireland
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Jones A, Amirjamshidi H, Olverson G, Ling FS, Hisamoto K. Transcatheter aortic valve replacement 23 years after heart transplant for aortic insufficiency. J Cardiothorac Surg 2023; 18:274. [PMID: 37805477 PMCID: PMC10560406 DOI: 10.1186/s13019-023-02407-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 09/30/2023] [Indexed: 10/09/2023] Open
Abstract
BACKGROUND Clinicians continue to expand the availability of transcatheter aortic valve replacement (TAVR) for patients who historically would have been ineligible for surgical aortic valve replacement. Historically, reoperative aortic valve surgery after transplant was immensely complicated and high risk due to the repeat sternotomy approach, and the immunosuppression in transplant patients. As heart transplant patients continue to live longer, patients are beginning to develop novo aortic pathology of the transplanted organ. In these patients, TAVR may be a valuable rescue therapy for those with de-novo aortic valve disease. CASE PRESENTATION Here, we present a single case of a 70-year-old man with a history of heart transplant 23 years prior complicated by severe sternal infection and subsequent removal of his sternum. Additionally, this patient had a recent history of kidney transplant due to renal cell carcinoma necessitating nephrectomy. He subsequently developed progressive symptomatic aortic insufficiency and underwent a successful TAVR to treat his new aortic disease. CONCLUSIONS To our knowledge, this represents only the second case report of TAVR for severe aortic insufficiency and one of the first reports of TAVR in a multiple organ recipient. TAVR may represent an important rescue therapy for post-transplant valve pathologies instead of high-risk reoperative surgical aortic valve replacement.
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Affiliation(s)
- Andrew Jones
- University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
| | - Hossein Amirjamshidi
- Division of Cardiac Surgery, Department of Surgery, University of Rochester Medical Center, 601 Elmwood Ave, Box: Surg, Rochester, NY, 14620, USA
| | - George Olverson
- University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
| | - Frederick S Ling
- Department of Medicine, Cardiology, University of Rochester Medical Center, Rochester, NY, USA
| | - Kazuhiro Hisamoto
- Division of Cardiac Surgery, Department of Surgery, University of Rochester Medical Center, 601 Elmwood Ave, Box: Surg, Rochester, NY, 14620, USA.
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Transcatheter Aortic Valve Replacement of a Bicuspid Aortic Valve in a Heart Transplant Recipient. JACC Case Rep 2020; 2:716-720. [PMID: 34317333 PMCID: PMC8302040 DOI: 10.1016/j.jaccas.2020.03.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Revised: 03/20/2020] [Accepted: 03/27/2020] [Indexed: 11/21/2022]
Abstract
Patients with heart transplants who present with severe aortic stenosis may be deemed high-risk surgical candidates due to immunosuppression and multiple comorbid conditions. Appropriately selected patients may be successfully treated with transcatheter aortic valve replacement. (Level of Difficulty: Advanced.)
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Wallen TJ, Spratt J, Kates MM, Wayangankar S, Vilaro J, Aranda J, Arnaoutakis GJ. Transcatheter aortic valve replacement 24 years after cardiac transplantation. J Card Surg 2020; 35:710-712. [PMID: 31971286 DOI: 10.1111/jocs.14438] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
As patient survival after cardiac transplantation has improved over the course of the last several decades, clinicians are now faced with late complications. This includes aortic stenosis which, traditionally, has been treated with reoperative sternotomy and aortic valve replacement. Transcather aortic valve replacement (TAVR) offers a minimally invasive alternative in this high-risk population. A small but growing number of cases of TAVR after heart transplantation in high-risk patients have been reported in the last 10 years; we now present a case of aortic valve replacement via a transcatheter approach 24 years after cardiac transplantation.
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Affiliation(s)
- Tyler J Wallen
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, The University of Florida, Gainesville, Florida
| | - John Spratt
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, The University of Florida, Gainesville, Florida
| | - Malcolm M Kates
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, The University of Florida, Gainesville, Florida
| | - Siddharth Wayangankar
- Division of Cardiology, Department of Medicine, The University of Florida, Gainesville, Florida
| | - Juan Vilaro
- Division of Cardiology, Department of Medicine, The University of Florida, Gainesville, Florida
| | - Juan Aranda
- Division of Cardiology, Department of Medicine, The University of Florida, Gainesville, Florida
| | - George J Arnaoutakis
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, The University of Florida, Gainesville, Florida
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Avula S, Mungee S, Barzallo MA. Successful minimal approach transcatheter aortic valve replacement in an allograft heart recipient 19 years post transplantation for severe aortic stenosis: A case report. World J Cardiol 2019; 11:209-212. [PMID: 31523399 PMCID: PMC6715582 DOI: 10.4330/wjc.v11.i8.209] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Revised: 08/02/2019] [Accepted: 08/07/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Aortic stenosis is one of the rare valvular complications in a transplanted heart. Over the past 8 years, transcatheter approach for aortic valve replacement (TAVR) has been slowly evolving to be the preferred approach in these patient population when compared to the surgical approach. We report a second case in the United States with successful transfemoral minimal approach with minimal sedation for TAVR in a heart transplant recipient 19 years post transplantation for severe symptomatic calcified aortic stenosis.
CASE SUMMARY We present a case of 73-year-old male who has undergone successful minimal approach transcatheter aortic valve replacement in an allograft heart. Patient had received orthotopic heart transplantation 19 years ago for non-ischemic cardiomyopathy. Follow up transthoracic echocardiograms as per routine protocol did not show any aortic valve disease until 15 years post transplantation. Aortic valve was noted to be mildly sclerotic at that time and gradually progressed to severe symptomatic aortic stenosis over the next 4 years. Patient had complaints of worsening shortness of breath that limited his functional capacity. Overall his post heart transplantation period has been mostly uneventful except for allograft non occlusive vasculopathy and aortic stenosis. His Society of Thoracic Surgery risk score was 12.205% and he was considered to be a high-risk surgical candidate by surgeon. Decision was made to undergo transcatheter aortic valve replacement.
CONCLUSION With the improved survival of these patients, we think it is time to look into pathophysiology of valvular disease in transplant heart recipients. Some other unanswered questions include, underlying donor and recipient risk factors for valvular diseases in heart transplant recipients.
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Affiliation(s)
- Sravani Avula
- Department of Cardiovascular Medicine, University of Illinois College of Medicine at Peoria, Peoria, IL 61637, United States
| | - Sudhir Mungee
- Department of Cardiovascular Medicine, University of Illinois College of Medicine at Peoria, Peoria, IL 61637, United States
| | - Marco A Barzallo
- Key Clinal Faculty, Department of Cardiovascular Medicine, University of Illinois College of Medicine at Peoria, Peoria, IL 61637, United States
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Akleh SI, Bandali A, Edwards R. Transcatheter aortic valve implantation in an orthotopic heart transplant recipient with bicuspid aortic valve. Clin Case Rep 2018; 6:2262-2265. [PMID: 30455933 PMCID: PMC6230648 DOI: 10.1002/ccr3.1845] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Revised: 07/01/2018] [Accepted: 09/13/2018] [Indexed: 11/06/2022] Open
Abstract
Increasing longevity of heart transplantation recipients and aging donor population accompanied by the older age at transplantation led to an increase in the prevalence of degenerative valvular disease in particular aortic stenosis. TAVI is considered a safe and feasible alternative compared to conventional SAVR in this high-risk population.
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Ahmad K, Terkelsen CJ, Terp KA, Mathiassen ON, Nørgaard BL, Andersen HR, Poulsen SH. Transcatheter aortic valve implantation in a young heart transplant recipient crossing the traditional boundaries. J Thorac Dis 2016; 8:E711-4. [PMID: 27621906 DOI: 10.21037/jtd.2016.07.61] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Transcatheter aortic valve implantation (TAVI) is an established therapeutic alternative to surgical aortic valve replacement (SAVR) in high-risk or inoperable patients with symptomatic aortic valve stenosis. Hitherto, TAVI is not recommended in young and low-intermediate risk patients. However, TAVI may also serve as an alternative to SAVR in selected young patients, e.g., patients who have previously undergone multiple cardiac surgery procedures. We report a case of trans-femoral TAVI in a 25-year-old heart transplant (HTx) recipient with prior surgery for congenital heart disease.
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Affiliation(s)
- Khalil Ahmad
- Department of Cardiothoracic and Vascular Surgery & Institute of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Christian Juhl Terkelsen
- Department of Cardiology & Institute of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Kim Allan Terp
- Department of Cardiothoracic and Vascular Surgery & Institute of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Ole Norling Mathiassen
- Department of Cardiology & Institute of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Bjarne Linde Nørgaard
- Department of Cardiology & Institute of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Henning Rud Andersen
- Department of Cardiology & Institute of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Steen Hvitfeldt Poulsen
- Department of Cardiology & Institute of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
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9
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Margale S, Natani S. Anesthetic Management of Transfemoral Transcatheter Aortic Valve Replacement (TAVR) in a Heart Transplant Recipient With Severely Depressed Left Ventricular Function and Renal Failure. J Cardiothorac Vasc Anesth 2016; 31:1032-1036. [PMID: 27693207 DOI: 10.1053/j.jvca.2016.07.026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2016] [Indexed: 12/15/2022]
Affiliation(s)
- Swaroop Margale
- Department of Anaesthesia and Perfusion Services, The Prince Charles Hospital, Brisbane, Australia; University of Queensland, Brisbane, Australia.
| | - Sarvesh Natani
- Department of Anaesthesia and Perfusion Services, The Prince Charles Hospital, Brisbane, Australia; University of Queensland, Brisbane, Australia
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10
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Transcatheter aortic valve implantation using the Lotus valve system in severe aortic stenosis in an orthotopic heart transplant patient. Int J Cardiol 2016; 207:192-3. [PMID: 26803241 DOI: 10.1016/j.ijcard.2016.01.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Accepted: 01/02/2016] [Indexed: 11/24/2022]
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Brill AK, Gloekler S, Aubert JD, Wenaweser PM, Geiser T. Transcatheter aortic valve implantation in a lung transplant recipient. Ann Thorac Surg 2014; 97:e159-60. [PMID: 24882332 DOI: 10.1016/j.athoracsur.2014.01.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2013] [Revised: 11/20/2013] [Accepted: 01/06/2014] [Indexed: 11/17/2022]
Abstract
Transcatheter aortic valve implantation is a feasible therapeutic option for selected patients with severe aortic stenosis and high or prohibitive risk for standard surgery. Lung transplant recipients are often considered high-risk patients for heart surgery because of their specific transplant-associated characteristics and comorbidities. We report a case of successful transfemoral transcatheter aortic valve replacement in a lung transplant recipient with a symptomatic severe aortic stenosis, severe left ventricular dysfunction, and end-stage renal failure 9 years after bilateral lung transplantation.
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Affiliation(s)
- Anne-Kathrin Brill
- Department of Pulmonary Medicine, University Hospital and University of Bern, Bern, Switzerland; Academic Department of Sleep and Breathing, Royal Brompton and Harefield NHS Foundation Trust, London, United Kingdom.
| | - Steffen Gloekler
- Cardiology, Cardiovascular Department, University Hospital and University of Bern, Bern, Switzerland
| | - John-David Aubert
- Service de Pneumologie et Centre Transplantation, University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Peter M Wenaweser
- Cardiology, Cardiovascular Department, University Hospital and University of Bern, Bern, Switzerland
| | - Thomas Geiser
- Department of Pulmonary Medicine, University Hospital and University of Bern, Bern, Switzerland
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Zanuttini D, Armellini I, Bisceglia T, Spedicato L, Bernardi G, Muzzi R, Proclemer A, Livi U. Transcatheter aortic valve implantation for degenerative aortic valve regurgitation long after heart transplantation. Ann Thorac Surg 2013; 96:1864-6. [PMID: 24182478 DOI: 10.1016/j.athoracsur.2013.03.040] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2012] [Revised: 02/14/2013] [Accepted: 03/18/2013] [Indexed: 12/15/2022]
Abstract
Transcatheter aortic valve implantation (TAVI) has become a feasible therapeutic option for the management of high-risk patients with severe degenerative aortic stenosis. Recently it has been extended to high-risk patients with severe aortic regurgitation. Degenerative aortic valve disease is generally uncommon in heart transplant recipients. We report the case of a 75-year-old man in whom severe degenerative aortic regurgitation developed 14 years after heart transplantation (HTx). Because of multiple comorbidities and high surgical risk, TAVI was preferred. A 29-mm CoreValve prosthesis (Medtronic Inc, Minneapolis, MN) was successfully implanted using a transfemoral approach.
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Affiliation(s)
- Davide Zanuttini
- Department of Cardiology, Santa Maria della Misericordia Hospital, Udine, Italy
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De Praetere H, Ciarka A, Dubois C, Herijgers P. Transapical transcatheter aortic valve implantation in a heart transplant recipient with severely depressed left ventricular function. Interact Cardiovasc Thorac Surg 2013; 16:906-8. [PMID: 23460597 DOI: 10.1093/icvts/ivt048] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Transcatheter aortic valve implantation (TAVI) is becoming a valuable alternative to surgical aortic valve replacement in non-operable and high-risk surgical patients. As the population of heart donors and recipients ages, the prevalence of degenerative valvular disease after transplantation will increase. The optimal treatment strategy of valvulopathies in these patients with extensive comorbidity is still unknown because of insufficient published experience. We present a heart transplant recipient with renal failure, systolic heart failure and severe aortic stenosis who was successfully treated with transapical TAVI.
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Cardiac transplantation in adults with aortic valve disease with focus on the bicuspid aortic valve. Am J Cardiol 2012; 109:1212-4. [PMID: 22260750 DOI: 10.1016/j.amjcard.2011.12.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2011] [Revised: 12/01/2011] [Accepted: 12/01/2011] [Indexed: 11/23/2022]
Abstract
The frequency of congenitally bicuspid aortic valves in patients having cardiac transplantation (CT) is unknown. We reviewed 243 explanted hearts in patients having CT at Baylor University Medical Center, Dallas from June 1997 through November 2011 to determine the frequency of a bicuspid aortic valve in this population. Of the 243 explanted hearts, 7 (2.9%) were found to have a congenitally bicuspid aortic valve: 3 had severe aortic valve stenosis and before CT had had the aortic valve replaced; the other 4 had normally functioning bicuspid valves and underwent CT for cardiomyopathy (ischemic in 1, idiopathic in 2, and hypertrophic in 1). Review of previously published reports of CT and aortic valve disease disclosed that 4 patients had had aortic valve replacement (AVR) from 2 to 8 years before CT, 3 had AVR or aortic valve repair of the donor heart at the time of CT, and 4 had AVR or transcatheter aortic valve implantation from 1 to 14 years after CT. Some of these aortic valve replacements, before, at the time of, or after CT were in patients with congenitally bicuspid aortic valves. In conclusion, congenitally bicuspid aortic valves were found in 7 of 243 explanted hearts in patients having CT at a single medical center in a 14-year period: 4 had functioned normally and 3 were severely stenotic. Previous reports of patients having AVR or repair before, during, and after CT were reviewed.
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