Department of Cardiology, Maimonides Medical Center, Brooklyn, NY, USA.
Section of Cardiovascular Research, Heart, Vascular, and Thoracic Department, Cleveland Clinic Akron General, Akron, OH, USA.
EuroIntervention. 2022 May 15;18(1):23-32. doi: 10.4244/EIJ-D-21-00757.
Limited information is available on outcomes in patients with bicuspid aortic valve (BAV) stenosis undergoing transcatheter aortic valve implantation (TAVI) compared with surgical aortic valve replacement (SAVR), as pivotal randomised trials excluded patients with BAV pathology due to anatomic complexity.
The aim of the study was to compare early outcomes between TAVI and SAVR in patients with BAV stenosis.
We queried the Nationwide Readmission Database (NRD) between 2016 and 2018 to identify adults who underwent TAVI or SAVR for BAV stenosis. The study's primary outcome was in-hospital mortality. Secondary outcomes were 30-day and six-month major adverse cardiovascular events (MACE). We matched both cohorts using propensity score matching, and applied logistic and Cox-proportional hazard regression to compute the odds ratio (OR), the hazard ratio (HR), and the 95% confidence interval (CI).
Out of 17,068 patients with BAV stenosis, 1,629 (9.5%) patients underwent TAVI and 15,439 (90.5%) underwent SAVR. After propensity score matching (PSM), we found 1,393 matched pairs. Of the matched pairs, 848 had complete six-month follow-ups. In the PSM cohort, TAVI was associated with reduced in-hospital mortality (0.7% vs 1.8%, OR: 0.35, 95% CI: 0.13-0.93; p=0.035), and a similar rate of MACE at 30 days (1% vs 1.5%, OR: 0.65, 95% CI: 0.27-1.58; p=0.343) and at six months (4.2% vs 4.9%, HR 0.86, 95% CI: 0.44-1.69; p=0.674), compared with SAVR.
In the propensity score-matched cohort, TAVI was associated with reduced odds of in-hospital mortality and a similar risk of 30-day and six-month MACE, supporting the feasibility of TAVI in BAV patients without a need for concurrent aortic root repair.
经导管主动脉瓣植入术（TAVI）与外科主动脉瓣置换术（SAVR）相比，在接受治疗的二叶式主动脉瓣狭窄（BAV）患者的结局方面，相关信息有限，这是因为关键性随机试验因解剖结构复杂而排除了患有 BAV 病理的患者。
本研究旨在比较 TAVI 与 SAVR 在 BAV 狭窄患者中的早期结局。
我们在 2016 年至 2018 年期间查询了全国再入院数据库（NRD），以确定接受 TAVI 或 SAVR 治疗的 BAV 狭窄成年患者。本研究的主要结局是住院期间死亡率。次要结局是 30 天和 6 个月的主要不良心血管事件（MACE）。我们使用倾向评分匹配对两个队列进行了匹配，并应用逻辑和 Cox 比例风险回归计算了比值比（OR）、风险比（HR）和 95%置信区间（CI）。
在 17068 例 BAV 狭窄患者中，有 1629 例（9.5%）接受了 TAVI 治疗，15439 例（90.5%）接受了 SAVR 治疗。经过倾向评分匹配（PSM）后，我们发现了 1393 对匹配。在匹配的对中，有 848 对完成了 6 个月的随访。在 PSM 队列中，TAVI 与降低住院死亡率相关（0.7%对 1.8%，OR：0.35，95%CI：0.13-0.93；p=0.035），且 30 天的 MACE 发生率相似（1%对 1.5%，OR：0.65，95%CI：0.27-1.58；p=0.343）和 6 个月时（4.2%对 4.9%，HR 0.86，95%CI：0.44-1.69；p=0.674），与 SAVR 相比。
在倾向评分匹配队列中，TAVI 与降低住院死亡率的可能性相关，且 30 天和 6 个月的 MACE 风险相似，这支持了在无需同期主动脉根部修复的情况下，在 BAV 患者中进行 TAVI 的可行性。
