Arai Takahide, Lefèvre Thierry, Hovasse Thomas, Morice Marie-Claude, Romano Mauro, Benamer Hakim, Garot Philippe, Hayashida Kentaro, Bouvier Erik, Chevalier Bernard
Ramsay Générale de Santé, Institut Cardiovasculaire Paris Sud, Hôpital Privé Jacques Cartier, Massy, France.
Ramsay Générale de Santé, Institut Cardiovasculaire Paris Sud, Hôpital Privé Jacques Cartier, Massy, France.
J Cardiol. 2017 Sep;70(3):220-224. doi: 10.1016/j.jjcc.2016.12.009. Epub 2017 Feb 10.
There are currently only limited data focusing on transcatheter aortic valve implantation (TAVI) for bicuspid aortic valves (BAV) patients using the Edwards SAPIEN (Irvine, CA, USA) 3 (S3) valve. The aim of this study was to evaluate the feasibility and efficacy of TAVI using the S3 in patients with BAV.
A total of 153 TAVI cases performed with the S3 were included. BAV was detected by multidetector computed tomography (MDCT) in 10 (7%) patients. The other patients had tricuspid aortic valves (TAV). The BAV and TAV groups were compared.
Patient age and logistic EuroSCORE were similar in the BAV and TAV groups. The calculated annulus average diameter (CAAD) by MDCT was significantly larger in the BAV group (26.5mm vs 23.7mm, p=0.036) as was the annular area by MDCT (562mm vs 446mm, p=0.033). On the other hand, the valve diameter/CAAD ratio was significantly lower in the BAV group (1.01 vs 1.06, p=0.010) as was the annular area oversizing percentage (3% vs 11%, p=0.033). There were no significant differences between the two groups regarding the frequency of paravalvular aortic leakage (PVL) ≥2 (0% vs 6%, p=0.492) and the 30-day mortality rate (0% vs 1%, p=0.799).
Although TAVI for BAV tended to be carried out with a less oversized valve compared to TAVI for TAV, the frequency of post-procedural PVL ≥2 was similarly low in the two groups. TAVI using the S3 in patients with BAV seems to be feasible.
目前仅有有限的数据聚焦于使用美国加利福尼亚州尔湾市爱德华兹公司的SAPIEN 3（S3）瓣膜对二叶式主动脉瓣（BAV）患者进行经导管主动脉瓣植入术（TAVI）。本研究的目的是评估使用S3瓣膜对BAV患者进行TAVI的可行性和疗效。
共纳入153例使用S3瓣膜进行的TAVI病例。通过多排螺旋计算机断层扫描（MDCT）在10例（7%）患者中检测到BAV。其他患者为三叶式主动脉瓣（TAV）。对BAV组和TAV组进行比较。
BAV组和TAV组患者的年龄和逻辑欧洲心脏手术风险评估系统（EuroSCORE）相似。MDCT计算的瓣环平均直径（CAAD）在BAV组显著更大（26.5mm对23.7mm，p = 0.036），MDCT测量的瓣环面积也是如此（562mm对446mm，p = 0.033）。另一方面，BAV组的瓣膜直径/CAAD比值显著更低（1.01对1.06，p = 0.010），瓣环面积过大百分比也是如此（3%对1%，p = 0.033）。两组在瓣周主动脉瓣反流（PVL）≥2级的发生率（0%对6%，p = 0.492）和30天死亡率（0%对1%，p = 0.799）方面无显著差异。
尽管与TAV的TAVI相比，BAV的TAVI倾向于使用尺寸较小的瓣膜，但两组术后PVL≥2级的发生率同样较低。对BAV患者使用S3瓣膜进行TAVI似乎是可行的。
