Division of Cardiology, Thomas Jefferson University Hospitals, Philadelphia, Pennsylvania, USA.
Department of Internal Medicine, Rochester Regional Health, Rochester, New York, USA.
Catheter Cardiovasc Interv. 2022 Nov;100(6):1119-1131. doi: 10.1002/ccd.30407. Epub 2022 Oct 2.
Transcatheter aortic valve implantation (TAVI) has increasingly been utilized in patients with bicuspid aortic valve (BAV) related aortic stenosis (AS) with insufficient large-scale data on its safety.
The Nationwide Inpatient Sample and Nationwide Readmission Database (2011-2018) were queried to identify patients undergoing TAVI for BAV versus trileaflet aortic valve (TAV) associated AS. The in-hospital, 30- and 180-day odds of outcomes were assessed using a propensity-matched analysis (PSM) to calculate adjusted odds ratios (aOR) with its 95% confidence interval (CI).
A total of 216,723 TAVI (TAV: 214,050 and BAV: 2,673) crude and 5,347 matched population (TAV: 2,674 and BAV: 2,673) was included in the final analysis. At index admission, the adjusted odds of in-hospital mortality (aOR: 1.57, 95% CI: 0.67-3.66), stroke (aOR: 0.77, 95% CI: 0.38-1.57), cardiac tamponade (aOR: 0.75, 95% CI: 0.17-3.36), vascular complications (aOR: 0.33, 95% CI: 0.09-1.22), cardiogenic shock (aOR: 1.77, 95% CI: 0.93-3.38), paravalvular leak (aOR: 0.55, 95% CI: 0.26-1.14), need for mechanical circulatory support device, and permanent pacemaker implantation (PPM) (aOR: 1.02, 95% CI: 0.69-1.52) were not significantly different between TAVI for BAV versus TAV. At 30- and 180-day follow-up duration, the risk of stroke and major postprocedural complications remained similar, except that TAVI in BAV had a higher incidence of PPM implantation compared with TAV. The yearly trend showed an increase in the utilization of TAVI for both TAV and BAV and a steady decline in the overall annual rate of in-hospital complications.
TAVI utilization in patients with BAV has increased over the recent years. The relative odds of in-hospital mortality, and all other major complications, were similar between patients undergoing TAVI for BAV- and TAV-related AS.
经导管主动脉瓣植入术（TAVI）已越来越多地用于治疗二叶式主动脉瓣（BAV）相关主动脉瓣狭窄（AS）患者，但关于其安全性的大规模数据仍不足。
利用国家住院患者样本和国家再入院数据库（2011-2018 年），确定接受 TAVI 治疗的 BAV 患者与三叶式主动脉瓣（TAV）相关 AS 患者。采用倾向匹配分析（PSM）评估住院、30 天和 180 天结局的比值比（OR），计算调整后的比值比（aOR）及其 95%置信区间（CI）。
共纳入 216723 例 TAVI（TAV：214050 例，BAV：2673 例）和 5347 例匹配人群（TAV：2674 例，BAV：2673 例）。在指数入院时，调整后的住院死亡率（aOR：1.57，95%CI：0.67-3.66）、卒中（aOR：0.77，95%CI：0.38-1.57）、心脏压塞（aOR：0.75，95%CI：0.17-3.36）、血管并发症（aOR：0.33，95%CI：0.09-1.22）、心源性休克（aOR：1.77，95%CI：0.93-3.38）、瓣周漏（aOR：0.55，95%CI：0.26-1.14）、需要机械循环支持装置和永久性心脏起搏器植入（PPM）（aOR：1.02，95%CI：0.69-1.52）的比值无明显差异。在 30 天和 180 天的随访期间，除了 TAVI 治疗 BAV 的患者 PPM 植入发生率高于 TAV 外，卒中及其他主要术后并发症的风险仍相似。年度趋势显示，TAVI 治疗 BAV 和 TAV 的使用率均有所增加，而住院并发症的总体年度发生率则呈稳定下降趋势。
近年来，BAV 患者 TAVI 的使用率有所增加。与 TAV 相关 AS 患者相比，BAV 患者接受 TAVI 治疗的院内死亡率和其他主要并发症的相对比值相似。
