Department of Cardiology, St. Paul's Hospital, Vancouver, British Columbia, Canada.
Department of Cardiology, Hadassah Hebrew University Medical Center, Jerusalem, Israel.
Catheter Cardiovasc Interv. 2020 May 1;95(6):1186-1192. doi: 10.1002/ccd.28475. Epub 2019 Sep 4.
OBJECTIVES: To perform clinical and echocardiographic follow-up beyond 1 year in consecutive patients with severe bicuspid aortic stenosis (AS) undergoing transcatheter aortic valve replacement (TAVR) with a current generation balloon-expandable valve. BACKGROUND: Treatment of bicuspid aortic valve disease with TAVR remains controversial and late follow-up data is still scarce. METHODS: We collected baseline characteristics, procedural data, 30-day and mid-term clinical follow-up findings from six centers in Europe and Canada from patients with bicuspid AS treated with TAVR using the SAPIEN 3 valve. RESULTS: Seventy-nine patients underwent TAVR. Mean age was 76 ± 9 years; median STS risk score for mortality was 3.8% (interquartile range 2.3-5.5%). Median follow-up was 390 days (interquartile range 138-739 days). Device success was achieved in 95% of patients. Postimplantation mean aortic gradient decreased from 50.2 ± 16.2 to 8.8 ± 4.4 mmHg and no patient had more than mild aortic regurgitation. At last follow-up, there was persistent good valve performance. At 30 days and 1 year, the rates of all-cause mortality were 3.8 and 7.7%, stroke 1.2 and 1.2%, and the rate of new pacemakers 18 and 18%. CONCLUSIONS: Our data confirm that treating patients with stenotic bicuspid aortic valves is safe, effective, and has favorable valve performance over time.
目的:对接受当前一代球囊扩张式经导管主动脉瓣置换术(TAVR)治疗的严重二叶式主动脉瓣狭窄(AS)连续患者进行超过 1 年的临床和超声心动图随访。
背景:TAVR 治疗二叶式主动脉瓣疾病仍存在争议,且迟发随访数据仍十分有限。
方法:我们从欧洲和加拿大的 6 个中心收集了 79 例接受 SAPIEN 3 瓣膜治疗的二叶式 AS 患者的基线特征、手术数据、30 天和中期临床随访结果。
结果:79 例患者接受了 TAVR。平均年龄为 76±9 岁;中位 STS 死亡率风险评分 3.8%(四分位距 2.3-5.5%)。中位随访时间为 390 天(四分位距 138-739 天)。95%的患者实现了器械成功。植入后平均主动脉瓣跨瓣压差从 50.2±16.2mmHg 降至 8.8±4.4mmHg,且无患者出现中重度主动脉瓣反流。在最后一次随访时,瓣膜仍保持良好的性能。30 天和 1 年时,全因死亡率分别为 3.8%和 7.7%,卒中发生率分别为 1.2%和 1.2%,新植入起搏器的比例分别为 18%和 18%。
结论:我们的数据证实,治疗狭窄性二叶式主动脉瓣患者是安全、有效的,且随着时间的推移瓣膜功能良好。