Yeats Breandan B, Yadav Pradeep K, Dasi Lakshmi P, Thourani Vinod H
Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA, USA.
Department of Cardiology, Marcus Valve Center, Piedmont Heart Institute, Atlanta, GA, USA.
Ann Cardiothorac Surg. 2022 Jul;11(4):389-401. doi: 10.21037/acs-2022-bav-20.
Bicuspid aortic valve (BAV) disease is the most common form of congenital heart valve defect. It is associated with aortic stenosis (AS), aortic insufficiency, and aortopathy. Treatment of severe AS requires valve replacement which historically has been performed with surgical aortic valve replacement (SAVR). Recently, transcatheter aortic valve replacement (TAVR) has emerged as a promising alternative. However, increased rates of adverse outcomes following TAVR have been shown in BAV patients with high amounts of calcification. Comparison between TAVR and SAVR in low surgical risk BAV patients in a randomized trial has not been performed and TAVR for BAV long-term performance is unknown due to lack of clinical data. Due to the complexity of BAV anatomies and the significant knowledge gap from the lack of clinical data, SAVR still has many benefits over TAVR in low surgical risk BAV patients. It also remains common for BAV patients to have an aortopathy, which currently can be treated with surgical techniques. This review aims to outline BAV associated diseases and their treatment strategies, the main TAVR adverse outcomes associated with anatomically complex BAV patients, TAVR strategies for mitigating these risks and the current state of cutting-edge 3D printing and computer modeling screening methods that can provide otherwise unobtainable preoperative information during the BAV patient selection process for TAVR.
二叶式主动脉瓣（BAV）疾病是先天性心脏瓣膜缺陷最常见的形式。它与主动脉狭窄（AS）、主动脉瓣关闭不全及主动脉病变相关。重度AS的治疗需要进行瓣膜置换，历史上一直采用外科主动脉瓣置换术（SAVR）。最近，经导管主动脉瓣置换术（TAVR）已成为一种有前景的替代方法。然而，在钙化程度高的BAV患者中，TAVR术后不良结局的发生率有所增加。尚未在一项随机试验中对低手术风险BAV患者的TAVR和SAVR进行比较，并且由于缺乏临床数据，BAV的TAVR长期性能尚不清楚。由于BAV解剖结构的复杂性以及缺乏临床数据导致的重大知识空白，在低手术风险BAV患者中，SAVR相对于TAVR仍有许多优势。BAV患者合并主动脉病变也很常见，目前可以通过手术技术进行治疗。本综述旨在概述BAV相关疾病及其治疗策略、与解剖结构复杂的BAV患者相关的主要TAVR不良结局、减轻这些风险的TAVR策略以及前沿的3D打印和计算机建模筛查方法的现状，这些方法可以在BAV患者TAVR选择过程中提供否则无法获得的术前信息。
