Phan Kevin, Wong Sophia, Phan Steven, Ha Hakeem, Qian Pierre, Yan Tristan D
The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia; Sydney Medical School, University of Sydney, Sydney, Australia; St Vincent's Clinical School, University of New South Wales, Sydney, Australia; Department of Cardiology, Westmead Hospital, Sydney, Australia.
Gosford Hospital, Gosford, Australia.
Heart Lung Circ. 2015 Jul;24(7):649-59. doi: 10.1016/j.hlc.2014.12.163. Epub 2015 Jan 28.
Transcatheter aortic valve implantation (TAVI) is a feasible interventional technique for severe aortic stenosis in patients who are deemed inoperable or at high surgical risk. There is limited evidence for the safety and efficacy of TAVI in patients with bicuspid aortic valves (BAV), the most common congenital valve abnormality. In many TAVI trials, patients with BAV have been contraindicated due to concerns surrounding abnormal valve geometry, leading to malfunction or malpositioning. A systematic review and meta-analysis was conducted in order to assess the current evidence and relative merits of TAVI in aortic stenosis patients with BAV.
From six electronic databases, seven articles including 149 BAV and 2096 non-BAV patients undergoing TAVI were analysed.
Between the BAV and no-BAV cohorts, there was no difference in 30-day mortality (8.3% vs 9.0%; P=0.68), post-TAVI mean peak gradients (weighted mean difference, 0.36 mmHg; P=0.55), moderate or severe paravalvular leak (25.7% vs 19.9%; P=0.29), pacemaker implantations (18.5% vs 27.9%; P=0.52), life-threatening bleeding (8.2% vs 13.9%; P=0.33), major bleeding (20% vs 16.8%; P=0.88), conversion to conventional surgery (1.9% vs 1.2%; P=0.18) and vascular complications (8.6% vs 10.1%; P=0.32).
Preliminary short and mid-term pooled data from observation studies suggest that TAVI is feasible and safe in older patients with BAV. While future randomised trials are not likely, larger adequately-powered multi-institutional studies are warranted to assess the long-term durability and complications associated with TAVI in older BAV patients with severe aortic stenosis.
经导管主动脉瓣植入术（TAVI）是一种适用于被认为无法进行手术或手术风险高的严重主动脉瓣狭窄患者的可行介入技术。对于最常见的先天性瓣膜异常——二叶式主动脉瓣（BAV）患者，TAVI安全性和有效性的证据有限。在许多TAVI试验中，由于担心瓣膜几何形状异常会导致功能故障或位置不当，BAV患者被排除在外。为了评估TAVI在BAV主动脉瓣狭窄患者中的现有证据和相对优点，进行了一项系统评价和荟萃分析。
从六个电子数据库中分析了七篇文章，包括149例接受TAVI的BAV患者和2096例非BAV患者。
在BAV组和非BAV组之间，30天死亡率（8.3%对9.0%；P=0.68）、TAVI术后平均峰值梯度（加权平均差，0.36mmHg；P=0.55）、中度或重度瓣周漏（25.7%对19.9%；P=0.29）、起搏器植入率（18.5%对27.9%；P=0.52）、危及生命的出血（8.2%对13.9%；P=0.33）、大出血（20%对16.8%；P=0.88）、转为传统手术（1.9%对1.2%；P=0.18）和血管并发症（8.6%对10.1%；P=0.32）均无差异。
观察性研究的初步短期和中期汇总数据表明，TAVI在老年BAV患者中是可行且安全的。虽然未来不太可能进行随机试验，但有必要开展规模更大、有足够样本量的多机构研究，以评估TAVI在老年重度主动脉瓣狭窄BAV患者中的长期耐久性和并发症情况。
