Cardiology Unit, Azienda Ospedaliero Universitaria di Ferrara Arcispedale Sant'Anna, Ferrara, Italy.
San Raffaele Scientific Institute, Milan, Italy.
Clin Res Cardiol. 2021 May;110(5):667-675. doi: 10.1007/s00392-020-01793-9. Epub 2021 Jan 3.
To define the incidence of high residual gradient (HRG) after transcatheter aortic valve replacement (TAVR) in BAVs and their impact on short term outcome and 1-year mortality.
Transcatheter heart valves (THVs) offer good performance in tricuspid aortic valves with low rate of HRG. However, data regarding their performance in bicuspid aortic valves (BAV) are still lacking.
The BEAT (Balloon vs Self-Expandable valve for the treatment of bicuspid Aortic valve sTenosis) registry included 353 consecutive patients who underwent TAVR (Evolut R/PRO or Sapien 3 valves) in BAV between June 2013 and October 2018. The primary endpoint was device unsuccess with post-procedural HRG (mean gradient ≥ 20 mmHg). The secondary endpoint was to identify the predictors of HRG following the procedure.
Twenty patients (5.6%) showed HRG after TAVR. Patients with HRG presented higher body mass index (BMI) (30.7 ± 9.3 vs. 25.9 ± 4.8; p < 0.0001) and higher baseline aortic mean gradients (57.6 ± 13.4 mmHg vs. 47.7 ± 16.6, p = 0.013) and more often presented with BAV of Sievers type 0 than patients without HRG. At multivariate analysis, BMI [odds ratio (OR) 1.12; 95% confidence interval (CI) 1.05-1.20, p = 0.001] and BAV type 0 (OR 11.31, 95% CI 3.45-37.06, p < 0.0001) were confirmed as independent predictors of high gradient.
HRG following TAVR in BAVs is not negligible and is higher among patients with high BMI and with BAV 0 anatomy.
定义经导管主动脉瓣置换术（TAVR）后，二叶式主动脉瓣（BAV）患者的高残余梯度（HRG）发生率及其对短期预后和 1 年死亡率的影响。
经导管心脏瓣膜（THV）在三尖瓣主动脉瓣中具有良好的性能，HRG 发生率较低。然而，关于其在二叶式主动脉瓣（BAV）中的性能的数据仍然缺乏。
BEAT（球囊与自膨式瓣膜治疗二叶式主动脉瓣狭窄）登记研究纳入了 2013 年 6 月至 2018 年 10 月期间 353 例连续接受 TAVR（Evolut R/PRO 或 Sapien 3 瓣膜）的 BAV 患者。主要终点是术后器械失败伴 HRG（平均梯度≥20mmHg）。次要终点是确定术后 HRG 的预测因素。
20 例（5.6%）患者在 TAVR 后出现 HRG。有 HRG 的患者体重指数（BMI）更高（30.7±9.3 比 25.9±4.8；p<0.0001），基线主动脉平均梯度更高（57.6±13.4mmHg 比 47.7±16.6mmHg，p=0.013），并且更常出现 Sievers 0 型 BAV，而无 HRG 的患者则较少出现。多变量分析证实，BMI[比值比（OR）1.12；95%置信区间（CI）1.05-1.20，p=0.001]和 BAV 0 型（OR 11.31，95%CI 3.45-37.06，p<0.0001）是 HRG 的独立预测因素。
TAVR 后 BAV 患者的 HRG 不容忽视，BMI 较高和 BAV 0 解剖结构的患者 HRG 更高。
