Xiong Tian-Yuan, Ali Walid Ben, Feng Yuan, Hayashida Kentaro, Jilaihawi Hasan, Latib Azeem, Lee Michael Kang-Yin, Leon Martin B, Makkar Raj R, Modine Thomas, Naber Christoph, Peng Yong, Piazza Nicolo, Reardon Michael J, Redwood Simon, Seth Ashok, Sondergaard Lars, Tay Edgar, Tchetche Didier, Yin Wei-Hsian, Chen Mao, Prendergast Bernard, Mylotte Darren
Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China.
Montreal Heart Institute, Montreal, Quebec, Canada.
Nat Rev Cardiol. 2023 Jan;20(1):52-67. doi: 10.1038/s41569-022-00734-5. Epub 2022 Jun 20.
Indications for transcatheter aortic valve implantation (TAVI) have expanded in many countries to include patients with aortic stenosis who are at low surgical risk, and a similar expansion to this cohort is anticipated elsewhere in the world, together with an increase in the proportion of patients with bicuspid aortic valve (BAV) morphology as the age of the patients being treated decreases. To date, patients with BAV have been excluded from major randomized trials of TAVI owing to anatomical considerations. As a consequence, BAV has been a relative contraindication to the use of TAVI in international guidelines. Although clinical experience and observational data are accumulating, BAV presents numerous anatomical challenges for successful TAVI, despite advances in device design. Furthermore, in those with BAV, substantial geographical variation exists in patient characteristics, clinical approach and procedural strategy. Therefore, in this Roadmap article, we summarize the existing evidence and provide consensus recommendations from an international group of experts on the application of TAVI in patients with BAV in advance of the anticipated growth in the use of this procedure in this challenging cohort of patients.
在许多国家，经导管主动脉瓣植入术（TAVI）的适应证已扩大到包括手术风险较低的主动脉瓣狭窄患者，预计世界其他地区也会对这一人群进行类似的适应证扩展，同时随着接受治疗患者年龄的降低，二叶式主动脉瓣（BAV）形态的患者比例也会增加。迄今为止，由于解剖学方面的考虑，BAV患者被排除在TAVI的主要随机试验之外。因此，BAV在国际指南中一直是使用TAVI的相对禁忌证。尽管临床经验和观察数据不断积累，但尽管器械设计有所进步，BAV在成功进行TAVI方面仍面临众多解剖学挑战。此外，在患有BAV的患者中，患者特征、临床方法和手术策略存在很大的地域差异。因此，在这篇路线图文章中，我们总结了现有证据，并在这一具有挑战性的患者群体中该手术预期使用量增加之前，提供了一组国际专家关于TAVI在BAV患者中应用的共识建议。
