Cedars-Sinai Medical Center, Heart Institute, Los Angeles, CA, United States of America.
Centre for Heart Valve Innovation, University of British Columbia, Vancouver, British Columbia, Canada.
Prog Cardiovasc Dis. 2020 Jul-Aug;63(4):482-487. doi: 10.1016/j.pcad.2020.06.007. Epub 2020 Jun 25.
Bicuspid aortic valve (BAV) is the most common congenital cardiac abnormality in adults, and symptoms typically develops in adulthood. In the majority of cases, BAV disease progresses with age and surgical aortic valve replacement (AVR) is performed with excellent operative outcomes. Based on a series of randomized trials, transcatheter AVR (TAVR) has evolved from a novel technology to an established therapy for patients with symptomatic severe aortic stenosis (AS) regardless of risk profile. Despite exclusion of bicuspid anatomy from the randomized trials, an increasing number of patients with BAV-AS have been treated with TAVR. Recent observational studies showed the comparable outcomes of TAVR between bicuspid and tricuspid AS. However, worse outcomes in patients with unfavorable bicuspid anatomy such as calcified raphe plus excessive leaflet calcification have raised concerns for TAVR in younger and lower risk population. For the further expansion of TAVR toward BAV-AS population, we need randomized trials of TAVR in this population. Until then, previous registry data combined with computed tomographic-based anatomical assessment may guide the optimal therapy in patients with bicuspid anatomy.
二叶式主动脉瓣（BAV）是成人中最常见的先天性心脏异常，其症状通常在成年后出现。在大多数情况下，BAV 疾病随年龄增长而进展，且大多数患者行主动脉瓣置换术（AVR）的手术效果极佳。基于一系列随机试验，经导管主动脉瓣置换术（TAVR）已从一项新技术发展为有症状的重度主动脉瓣狭窄（AS）患者的既定治疗方法，无论风险状况如何。尽管随机试验排除了二叶式解剖结构，但越来越多的 BAV-AS 患者接受了 TAVR 治疗。最近的观察性研究表明，在二叶式和三叶式 AS 患者中，TAVR 的结果相当。然而，在瓣叶钙化嵴和瓣叶过度钙化等不利二叶式解剖结构的患者中，预后更差，这使得人们对 TAVR 在年轻和低危人群中的应用产生了担忧。为了将 TAVR 进一步扩展至 BAV-AS 人群，我们需要在该人群中进行 TAVR 的随机试验。在此之前，结合基于计算机断层扫描的解剖评估的先前登记数据可能有助于指导二叶式解剖结构患者的最佳治疗方案。
