Dai Hanyi, Fan Jiaqi, He Yuxin, Chen Jun, Zhou Dao, Yidilisi Abuduwufuer, Qi Xinrui, Li Ranxi, Liu Xianbao, Wang Jian'an
Department of Cardiology, The Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou 310009, China.
J Clin Med. 2023 Jan 1;12(1):343. doi: 10.3390/jcm12010343.
Background: Comparative data of the Valve Academic Research Consortium (VARC-3)-defined technical success between bicuspid versus tricuspid aortic stenosis (AS) remain lacking. Aims: We sought to compare the technical success and other clinical outcomes between patients with bicuspid and tricuspid AS receiving transcatheter aortic valve replacement. Methods: A registration-based analysis was performed for 402 patients (211 and 191 cases of bicuspid and tricuspid AS, respectively). The primary outcome was VARC-3-defined technical success. Additional analysis was performed to assess outcomes for up to one year between the two groups. Results: Bicuspid AS patients tended to be younger (74 years vs. 77 years; p < 0.001) with a lower Society of Thoracic Surgeons score (4.4% vs. 5.4%; p = 0.003). Bicuspid AS patients showed a lower prevalence of hypertension and peripheral vascular diseases. Technical failure was encountered in 17.7% of these patients, driven primarily by the high incidence of second valve implantation. The technical success rates were comparable between the bicuspid and tricuspid AS groups (82.5% vs. 82.2%, p = 0.944). Chronic kidney disease (CKD) and larger sinotubular junctional diameter (STJ) were identified as predictors of technical failure, whereas CKD, impaired left ventricular ejection fraction (LVEF), along with larger STJ, were predictors of cardiac technical failure. Technical failure was associated with an increased risk of all-cause mortality at 30 days and 1 year, as evidenced by the Cox multivariable analysis. Conclusions: No significant differences were observed in the technical success rates and most clinical outcomes between the bicuspid and tricuspid AS groups. Technical failure conferred an increased risk for both 30-day and 1-year all-cause mortalities.
关于双叶式与三叶式主动脉瓣狭窄（AS）之间由瓣膜学术研究联盟（VARC - 3）定义的技术成功率的对比数据仍然缺乏。
我们旨在比较接受经导管主动脉瓣置换术的双叶式和三叶式AS患者的技术成功率及其他临床结局。
对402例患者（分别为211例双叶式AS和191例三叶式AS）进行基于注册的分析。主要结局是VARC - 3定义的技术成功。进行了额外分析以评估两组长达一年的结局。
双叶式AS患者往往更年轻（74岁对77岁；p < 0.001），胸外科医师协会评分更低（4.4%对5.4%；p = 0.003）。双叶式AS患者高血压和外周血管疾病的患病率较低。这些患者中有17.7%遭遇技术失败，主要原因是二次瓣膜植入的高发生率。双叶式和三叶式AS组的技术成功率相当（82.5%对82.2%，p = 0.944）。慢性肾脏病（CKD）和更大的窦管交界直径（STJ）被确定为技术失败的预测因素，而CKD、左心室射血分数（LVEF）受损以及更大的STJ是心脏技术失败的预测因素。Cox多变量分析表明，技术失败与30天和1年时全因死亡率增加的风险相关。
双叶式和三叶式AS组在技术成功率和大多数临床结局方面未观察到显著差异。技术失败使30天和1年全因死亡率的风险增加。
