Department of Cardiology, Assistance Publique-Hôpitaux de Paris, Bichat-Claude Bernard Hospital, Paris, France.
Am J Cardiol. 2012 Sep 15;110(6):877-83. doi: 10.1016/j.amjcard.2012.04.064. Epub 2012 Jun 6.
Little is known about transcatheter aortic valve implantation (TAVI) in patients with bicuspid aortic valve stenosis, which usually represents a contraindication. The aim of this study was to assess the feasibility and the results of TAVI in this patient subset. Of 316 high-risk patients with severe aortic stenosis who underwent TAVI from January 2009 to January 2012, 15 (5%) had documented bicuspid aortic valves. They were treated using a transarterial approach, using the Medtronic CoreValve system. Patients were aged 80 ± 10 years, in New York Heart Association functional classes III and IV. The mean aortic valve area was 0.8 ± 0.3 cm(2), and the mean gradient was 60 ± 19 mm Hg. The mean calcium score, calculated using multislice computed tomography, was 4,553 ± 1,872 arbitrary units. The procedure was successful in all but 1 patient. Major adverse events, according to Valvular Academic Research Consortium definitions, were encountered in 1 patient (death). The mean postimplantation prosthetic gradient was 11 ± 4 mm Hg, and ≤1+ periprosthetic leaks were observed in all but 2 patients. The mean prosthetic ellipticity index was 0.7 ± 0.2 at the level of the native annulus and 0.8 ± 0.2 at the level of the prosthetic leaflets. After a mean follow-up period of 8 ± 7 months, 1 patient had died from aortic dissection; there were no additional adverse events. All but 2 hospital survivors were in New York Heart Association class I or II. In conclusion, the present series suggests that transarterial Medtronic CoreValve implantation is feasible in selected patients with bicuspid aortic valve and may lead to short-term hemodynamic and clinical improvement.
关于经导管主动脉瓣植入术（TAVI）在二叶式主动脉瓣狭窄患者中的应用知之甚少，通常被视为禁忌证。本研究旨在评估该患者亚组中 TAVI 的可行性和结果。2009 年 1 月至 2012 年 1 月期间，316 例高危严重主动脉瓣狭窄患者接受 TAVI，其中 15 例（5%）患者的主动脉瓣为二叶式。采用经动脉入路，使用美敦力 CoreValve 系统进行治疗。患者年龄 80±10 岁，纽约心脏协会功能分级 III 级和 IV 级。平均主动脉瓣口面积为 0.8±0.3cm²，平均跨瓣压差为 60±19mmHg。采用多层螺旋 CT 计算平均钙评分，为 4553±1872 个任意单位。除 1 例患者外，其余患者均手术成功。根据 Valvular Academic Research Consortium 定义，1 例患者（死亡）发生主要不良事件。植入后平均人工瓣压差为 11±4mmHg，除 2 例患者外，其余患者均存在≤1+瓣周漏。人工瓣瓣环水平的平均瓣环椭圆指数为 0.7±0.2，瓣叶水平为 0.8±0.2。平均随访 8±7 个月后，1 例患者因主动脉夹层死亡；无其他不良事件发生。除 2 例住院幸存者外，其余患者均为纽约心脏协会心功能分级 I 级或 II 级。总之，本研究提示，经动脉美敦力 CoreValve 植入术在特定的二叶式主动脉瓣患者中是可行的，可能导致短期血流动力学和临床改善。
