Groupe CardioVasculaire Interventionnel, Clinique Pasteur, Toulouse, France (D.T., C.d.B., R.P., J.M.-M.d.N., N.D.).
Thoraxcenter, Erasmus Medical Center, Rotterdam, the Netherlands (L.v.G., N.M.V.M.).
Circ Cardiovasc Interv. 2019 Jan;12(1):e007107. doi: 10.1161/CIRCINTERVENTIONS.118.007107.
Sizing for transcatheter aortic valve implantation in bicuspid aortic valves (BAV) remains controversial.
The aim of the BAVARD (Bicuspid Aortic Valve Anatomy and Relationship With Devices) retrospective registry is to capture the sizing ratios used for transcatheter aortic valve implantation in BAV and analyze the second-generation prostheses geometry postimplantation. About 101 patients with BAV along with available pre- and post-transcatheter aortic valve implantation multidetector computed tomography were compared with 88 tricuspid aortic valves (TAV) patients. Preprocedural multidetector computed tomography diagnosed type 0 and type 1 BAV in, respectively, 12.9% and 86.1 % of BAV. At baseline, the ellipticity index was similar between BAV and TAV patients: 1.2±0.1 versus 1.2±0.1, P=0.09. The mean annular oversizing was, respectively, 1.14±0.04 and 1.04±0.04, P<0.001, in TAV and BAV patients. The mean prosthesis intercommissural distance, ratio was 1.03±0.1. The mean diameter of the prostheses at the annulus matched the mean perimeter-derived diameter of the aortic annulus at baseline with TAV (23.3±2.2 versus 23.6±1.9, P=0.4) and was smaller with BAV (24±2.8 versus 26.8±3.1, P<0.01), confirming 11% underexpansion in BAV. Finally, in situ, prosthesis diameter and ellipticity followed the same pattern, with stable values from the distal edge to 12 mm above, in both groups.
Second-generation prostheses similarly reshape the aortic annulus in TAV and BAV. Prostheses keep consistent diameters from distal edge to 12 mm in TAV and BAV. Prosthesis underexpansion is constantly observed in BAV. Annular-based sizing is accurate in BAV with minimal oversizing. The intercommissural distance, 4 mm above the annulus, could be integrated in gray zones.
URL: https://www.clinicaltrials.gov . Unique identifier: NCT03495050.
在二叶式主动脉瓣（BAV）中进行经导管主动脉瓣植入术的尺寸选择仍存在争议。
BAVAR（二叶式主动脉瓣解剖结构与器械的关系）回顾性注册研究旨在获取二叶式主动脉瓣经导管主动脉瓣植入术中使用的尺寸比，并分析植入后的第二代假体几何形状。对 101 例 BAV 患者和 88 例三尖瓣主动脉瓣（TAV）患者的术前和术后多排螺旋 CT 进行了比较。术前多排螺旋 CT 诊断 BAV 分别为 0 型和 1 型的比例为 12.9%和 86.1%。基线时，BAV 和 TAV 患者的椭圆指数相似：1.2±0.1 比 1.2±0.1，P=0.09。TAV 和 BAV 患者的平均瓣环过度扩张分别为 1.14±0.04 和 1.04±0.04，P<0.001。假体间交通距离的平均比值为 1.03±0.1。在 TAV 中，假体的平均直径与基线时主动脉瓣环的平均周长衍生直径相匹配（23.3±2.2 比 23.6±1.9，P=0.4），而在 BAV 中则较小（24±2.8 比 26.8±3.1，P<0.01），证实 BAV 存在 11%的扩张不足。最后，在原位，两组的假体直径和椭圆度均从远端到 12mm 上方呈现出相同的模式，保持稳定的数值。
第二代假体在 TAV 和 BAV 中同样重塑主动脉瓣环。假体在 TAV 和 BAV 中从远端到 12mm 处保持一致的直径。在 BAV 中始终观察到假体扩张不足。基于瓣环的尺寸选择在 BAV 中是准确的，仅有最小的过度扩张。瓣环上方 4mm 的瓣间距离可整合到灰色区域。
