St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada.
JACC Cardiovasc Interv. 2010 Nov;3(11):1122-5. doi: 10.1016/j.jcin.2010.08.016.
We evaluated transcatheter aortic valve implantation (TAVI) in high-risk patients with bicuspid aortic valve (BAV) stenosis.
TAVI shows promise in the treatment of severe stenosis of triscupid aortic valves, especially in high-risk patients. However, BAV stenosis has been considered a contraindication to TAVI.
Eleven patients (age 52 to 90 years) with symptomatic severe BAV stenosis underwent TAVI at 3 Canadian tertiary hospitals between May 2006 and April 2010. All patients were considered high risk for surgical aortic valve replacement. Edwards-SAPIEN transcatheter heart valves (Edwards Lifesciences, Inc., Irvine, California) were used. Transfemoral or transapical access was selected, depending on the adequacy of femoral access.
Access was transfemoral in 7 patients and transapical in 4 patients. There were no intraprocedural complications. Significant symptomatic and hemodynamic improvement was observed in 10 of 11 patients. Baseline aortic valve area of 0.65 ± 0.17 cm(2) and mean transaortic pressure gradient of 41 ± 22.4 mm Hg were improved to 1.45 ± 0.3 cm(2) and 13.4 ± 5.7 mm Hg, respectively. Two patients had moderate perivalvular leaks. At the 30-day follow-up there were 2 deaths due to multisystem failure in 2 transapical patients. In 1 patient an undersized, suboptimally positioned, unstable valve required late conversion to open surgery.
TAVI in selected high-risk patients with severe BAV stenosis can be successfully performed with acceptable clinical outcomes but will require further evaluation.
我们评估了经导管主动脉瓣植入术（TAVI）在二叶式主动脉瓣（BAV）狭窄高危患者中的应用。
TAVI 显示出在治疗三叶式主动脉瓣严重狭窄方面的潜力，尤其是在高危患者中。然而，BAV 狭窄一直被认为是 TAVI 的禁忌症。
2006 年 5 月至 2010 年 4 月，在加拿大的 3 家三级医院，对 11 例（年龄 52 至 90 岁）有症状的严重 BAV 狭窄的患者进行了 TAVI。所有患者均被认为有外科主动脉瓣置换的高危风险。使用 Edwards-SAPIEN 经导管心脏瓣膜（爱德华生命科学公司，加利福尼亚州欧文市）。根据股动脉入路的充分性，选择经股动脉或经心尖入路。
7 例患者采用经股动脉入路，4 例患者采用经心尖入路。术中无并发症。11 例患者中有 10 例患者观察到明显的症状和血流动力学改善。主动脉瓣瓣口面积从 0.65±0.17cm2 增加到 1.45±0.3cm2，平均跨瓣压差从 41±22.4mmHg 降低到 13.4±5.7mmHg。2 例患者有中度瓣周漏。30 天随访时，2 例经心尖入路的患者因多系统衰竭死亡。1 例患者因植入的瓣膜尺寸过小、位置不佳、不稳定而需要晚期转为开放手术。
在选择的高危、严重 BAV 狭窄患者中，TAVI 可成功实施，临床结果可接受，但仍需进一步评估。
