Kanjanahattakij Napatt, Horn Benjamin, Vutthikraivit Wasawat, Biso Sylvia Marie, Ziccardi Mary Rodriguez, Lu Marvin Louis Roy, Rattanawong Pattara
Department of Medicine, Einstein Medical Center, Philadelphia, Pennsylvania.
Department of Medicine, Texas Tech University Health Sciences Center, Lubbock, Texas.
Clin Cardiol. 2018 Jul;41(7):896-902. doi: 10.1002/clc.22992. Epub 2018 Jul 18.
Transcatheter aortic valve replacement (TAVR) has become an alternative treatment to surgery in patients with severe aortic stenosis. However, patients with bicuspid aortic stenosis (BAV) are usually excluded from major TAVR studies. The aim of this study is to reexamine current evidence of TAVR in patients with severe aortic stenosis and BAV compared with tricuspid aortic valve (TAV).
There might be differences in outcomes post TAVR between patients with BAV comparing to TAV.
Databases were systematically searched for relevant articles featuring cohort studies that included patients with BAV and TAV who underwent TAVR studies, of which reported outcomes of interest included mortality and complications in both groups. Pooled effect size was calculated with a random-effect model and weighted for the inverse of variance, to compare outcomes post-TAVR between BAV and TAV.
Nine studies were included in the meta-analysis. There was no difference in 30-day mortality rate in patients with BAV compared with TAV (OR: 1.27, 95% CI: 0.84-1.93, I = 0). Patients with BAV were more likely to have a moderate to severe paravalvular leak (9 studies; OR: 1.42, 95% CI: 1.08-1.87, I = 0) and conversion to surgery (5 studies; OR: 5.48, 95% CI: 1.74-17.27, I = 0), and less likely to have device success compared with patients with TAV (5 studies; OR: 0.57, 95% CI: 0.40-0.81, I = 0%).
There was no difference in mortality post-TAVR in patients with BAV compared with TAV. Further randomized studies should be done in newer-generation prostheses to assess this association.
经导管主动脉瓣置换术（TAVR）已成为严重主动脉瓣狭窄患者手术治疗的替代方案。然而，二叶式主动脉瓣狭窄（BAV）患者通常被排除在主要的TAVR研究之外。本研究的目的是重新审视与三叶式主动脉瓣（TAV）相比，严重主动脉瓣狭窄合并BAV患者接受TAVR的现有证据。
与TAV患者相比，BAV患者TAVR术后的结局可能存在差异。
系统检索数据库，查找有关队列研究的相关文章，这些研究纳入了接受TAVR的BAV和TAV患者，其中感兴趣的报告结局包括两组的死亡率和并发症。采用随机效应模型计算合并效应量，并对方差的倒数进行加权，以比较BAV和TAV患者TAVR术后的结局。
荟萃分析纳入了9项研究。与TAV患者相比，BAV患者30天死亡率无差异（比值比：1.27，95%置信区间：0.84-1.93，I² = 0）。BAV患者更有可能出现中重度瓣周漏（9项研究；比值比：1.42，95%置信区间：1.08-1.87，I² = 0）和转为手术治疗（5项研究；比值比：5.48，95%置信区间：1.74-17.27，I² = 0），与TAV患者相比，器械成功的可能性较小（5项研究；比值比：0.57，95%置信区间：0.
