Chodór Piotr A, Wilczek Krzysztof, Chodór-Rozwadowska Karolina, Przybylski Roman, Głowacki Jan, Niklewski Tomasz, Włoch Łukasz, Gąsior Mariusz, Zembala Marian, Kalarus Zbigniew
Department of Cardiology, Congenital Heart Diseases and Electrotherapy, Medical University of Silesia, Silesian Center for Heart Diseases, Zabrze, Poland.
3 Department of Cardiology, Medical University of Silesia, Silesian Center for Heart Diseases, Zabrze, Poland.
Postepy Kardiol Interwencyjnej. 2021 Mar;17(1):82-92. doi: 10.5114/aic.2021.104773. Epub 2021 Mar 27.
Indications for transcatheter aortic valve implantation (TAVI) are constantly expanding, including younger patients. Bicuspid aortic valves (BAV) often occur in this group. In order to achieve optimal treatment results in younger patients, it is necessary to develop an effective method for selecting the size of implanted valves.
To compare the results of TAVI with use of a self-expanding prosthesis in patients with a BAV and a tricuspid aortic valve (TAV) with valve selection based on annular sizing.
The diagnosis of BAV and TAV and measurements (annular sizing) were based on multi-slice computed tomography scans. Eighty-three patients received a self-expanding CoreValve or Evolut R prosthesis. In group I (BAV) there were 21 (25.3%) patients and in group II (TAV) there were 62 (74.7%) patients.
The groups did not differ in terms of baseline clinical characteristics. Device success was achieved in 16 (76.2%) and 55 (88.7%) ( = NS) in group I and II respectively. Composite endpoints: early safety occurred in 5 (23.8%) and 11 (17.7%) patients ( =NS) in group I and II respectively; clinical efficacy occurred in 10 (47.6%) and 28 (45.2%) patients ( = NS) in group I and II respectively. 30-day mortality was 4.8% vs 9.7%, 1-year mortality was 28.6% vs 17.7% ( = NS) in group I and II respectively.
TAVI in patients with severe aortic stenosis and BAV is as effective as in patients with TAV using self-expanding prostheses if the valve selection is based on annular sizing.
经导管主动脉瓣植入术（TAVI）的适应症在不断扩大，包括年轻患者。这一群体中常出现二叶式主动脉瓣（BAV）。为了在年轻患者中取得最佳治疗效果，有必要开发一种有效的方法来选择植入瓣膜的尺寸。
比较在二叶式主动脉瓣（BAV）和三叶式主动脉瓣（TAV）患者中使用自膨胀式假体进行TAVI并基于瓣环尺寸选择瓣膜的结果。
BAV和TAV的诊断以及测量（瓣环尺寸）基于多层计算机断层扫描。83例患者接受了自膨胀式CoreValve或Evolut R假体。I组（BAV）有21例（25.3%）患者，II组（TAV）有62例（74.7%）患者。
两组在基线临床特征方面无差异。I组和II组分别有16例（76.2%）和55例（88.7%）实现了器械成功（P = 无显著差异）。复合终点：I组和II组分别有5例（23.8%）和11例（17.7%）患者出现早期安全性（P =无显著差异）；I组和II组分别有10例（47.6%）和28例（45.2%）患者出现临床疗效（P = 无显著差异）。I组和II组的30天死亡率分别为4.8%和9.7%，1年死亡率分别为28.6%和17.7%（P = 无显著差异）。
对于严重主动脉瓣狭窄且为BAV的患者，如果基于瓣环尺寸选择瓣膜，TAVI与使用自膨胀式假体的TAV患者一样有效。
