Department of Cardiology, Shonan Kamakura General Hospital, Kamakura, Japan; Heart and Lung Center, Helsinki University Hospital, Helsinki, Finland.
Heart and Lung Center, Helsinki University Hospital, Helsinki, Finland.
Am J Cardiol. 2022 Aug 1;176:96-104. doi: 10.1016/j.amjcard.2022.04.037. Epub 2022 May 25.
Recent studies showed the favorable outcomes of transcatheter aortic valve implantation (TAVI) in patients with bicuspid aortic valve (BAV) stenosis. However, data on the relation between BAV morphology and optimal transcatheter heart valve (THV) selection are limited. This study sought to evaluate the determinants of device performance in patients with BAV who underwent TAVI. Consecutive patients with BAV who underwent TAVI with the SAPIEN 3 from multicenters were evaluated. Outcomes were the incidence and predictors of device failure. Device failure was defined as peak aortic velocity >3.0 m/s, mean pressure gradient >20 mm Hg, moderate or severe paravalvular leakage and/or procedure mortality. A total of 187 patients with BAV were identified, aged 77 years, and 38.0% were women. A total of 37 patients (19.8%) were treated with 23-mm valve, 58 (31.0%) with 26-mm valve, and 92 (49.2%) with 29-mm valve. Predischarge echocardiogram demonstrated 37 patients (19.8%) with device failure. BAV with excessive leaflet calcification plus calcified raphe (EC-BAV) (OR 16.7, 95% CI 1.99 to 39.6) and smaller THV (OR 4.41, 95% CI 1.43 to 13.6) were independently associated with increased risk of device failure. In addition, 4.0%, 5.1%, and 11.1% of device failures were observed in patients without EC-BAV who underwent TAVI with 23-, 26- and 29-mm THV (p = 0.47), respectively, and 91.7%, 31.6% and 23.2% in those with EC-BAV, respectively (p <0.001). In conclusion, EC-BAV morphology was the major determinant of a device failure after TAVI. Moreover, TAVI in patients with EC-BAV requiring small SAPIEN 3 could be challenging. Further data on device and treatment selection in patients with BAV are still warranted.
最近的研究表明，经导管主动脉瓣植入术（TAVI）在二叶式主动脉瓣（BAV）狭窄患者中具有良好的效果。然而，关于 BAV 形态与最佳经导管心脏瓣膜（THV）选择之间关系的数据有限。本研究旨在评估接受 TAVI 的 BAV 患者的器械性能决定因素。 对多中心接受 SAPIEN 3 行 TAVI 的 BAV 连续患者进行了评估。结果是器械失败的发生率和预测因素。器械失败定义为峰值主动脉速度>3.0m/s，平均压力梯度>20mmHg，中度或重度瓣周漏和/或手术死亡率。共确定了 187 例 BAV 患者，年龄 77 岁，38.0%为女性。37 例（19.8%）接受 23mm 瓣膜治疗，58 例（31.0%）接受 26mm 瓣膜治疗，92 例（49.2%）接受 29mm 瓣膜治疗。出院前超声心动图显示 37 例（19.8%）器械失败。BAV 伴有过度瓣叶钙化加钙化嵴（EC-BAV）（OR 16.7，95%CI 1.99 至 39.6）和较小的 THV（OR 4.41，95%CI 1.43 至 13.6）与器械失败风险增加独立相关。此外，无 EC-BAV 的患者分别接受 23mm、26mm 和 29mm THV 的 TAVI 后，器械失败的发生率分别为 4.0%、5.1%和 11.1%（p=0.47），而有 EC-BAV 的患者分别为 91.7%、31.6%和 23.2%（p<0.001）。结论：EC-BAV 形态是 TAVI 后器械失败的主要决定因素。此外，对于需要小 SAPIEN 3 的 EC-BAV 患者，TAVI 可能具有挑战性。仍需要进一步的数据来确定 BAV 患者的器械和治疗选择。
