二尖瓣主动脉瓣狭窄患者植入Myval后的一年结局——一项多中心真实世界经验

One-Year Outcomes after Myval Implantation in Patients with Bicuspid Aortic Valve Stenosis-A Multicentre Real-World Experience.

作者信息

Elkoumy Ahmed, Jose John, Terkelsen Christian Juhl, Nissen Henrik, Gunasekaran Sengottuvelu, Abdelshafy Mahmoud, Seth Ashok, Elzomor Hesham, Kumar Sreenivas, Bedogni Francesco, Ielasi Alfonso, Arsang-Jang Shahram, Dora Santosh Kumar, Chandra Sharad, Parikh Keyur, Unic Daniel, Baumbach Andreas, Serruys Patrick, Soliman Osama

机构信息

Health Service Executive and CORRIB Core Lab, Discipline of Cardiology, Saolta Group, Galway University Hospital, University of Galway, H91 V4AY Galway, Ireland.

Islamic Center of Cardiology, Al-Azhar University, Cairo 11651, Egypt.

出版信息

J Clin Med. 2023 Mar 20;12(6):2398. doi: 10.3390/jcm12062398.

DOI:10.3390/jcm12062398

PMID:36983397

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10054138/

Abstract

BACKGROUND

Bicuspid aortic valve (BAV) affects approximately 1.5% of the general population and is seen in nearly 50% of candidates for aortic valve replacement (AVR). Despite increasingly utilised transcatheter aortic valve implantation (TAVI) in aortic stenosis (AS) patients, its use among patients with severe bicuspid AS is limited as BAV is a heterogeneous disease associated with multiple and complex anatomical challenges.

AIM

To investigate the one-year outcomes of TAVI using the balloon-expandable Myval transcatheter heart valve (THV) (Meril Life Sciences Pvt. Ltd., Vapi, India) in patients with severe bicuspid AS.

METHODS AND RESULTS

We collected data from consecutive patients with bicuspid AS who underwent TAVI with the Myval THV and had at least one-year follow-up. Baseline characteristics, procedural, and 30-day echocardiographic and clinical outcomes were collected. Sixty-two patients were included in the study. The median age was 72 [66.3, 77.0] years, 45 (72.6%) were males, and the mean STS PROM score was 3.2 ± 2.2%. All TAVI procedures were performed via the transfemoral route. The median follow-up duration was 13.5 [12.2, 18.3] months; all-cause mortality was reported in 7 (11.3%) patients and cardiovascular hospitalisation in 6 (10.6%) patients. All-stroke was reported in 2 (3.2%), permanent pacemaker implantation 5 (8.3%), and myocardial infarction 1 (1.6%) patients. The echocardiographic assessment revealed a mean pressure gradient of 10 [8, 16.5] mmHg, effective orifice area 1.7 [1.4, 1.9] cm, moderate AR in 1 (2%), mild AR in 14 (27%), and none/trace AR in 37 (71%). In total, 1 patient was diagnosed with valve thrombosis (2.1%), Stage II (moderate) haemodynamic deterioration was seen in 3 (6.4%), and stage III (severe) haemodynamic deterioration in 1 (2.1%) patient.

CONCLUSIONS

TAVI with the Myval THV in selected BAV anatomy is associated with favourable one-year hemodynamic and clinical outcomes.

摘要

背景

二叶式主动脉瓣（BAV）影响约1.5%的普通人群，在近50%的主动脉瓣置换术（AVR）候选患者中可见。尽管经导管主动脉瓣植入术（TAVI）在主动脉瓣狭窄（AS）患者中越来越多地被使用，但其在严重二叶式AS患者中的应用有限，因为BAV是一种与多种复杂解剖学挑战相关的异质性疾病。

目的

研究使用球囊扩张式Myval经导管心脏瓣膜（THV）（印度瓦皮市Meril生命科学私人有限公司）对严重二叶式AS患者进行TAVI的一年期结果。

方法和结果

我们收集了连续接受Myval THV TAVI且至少随访一年的二叶式AS患者的数据。收集了基线特征、手术过程以及30天的超声心动图和临床结果。62例患者纳入研究。中位年龄为[66.3, 77.0]岁，45例（72.6%）为男性，平均STS PROM评分为3.2±2.2%。所有TAVI手术均通过经股动脉途径进行。中位随访时间为[12.2, 18.3]个月；7例（11.3%）患者报告全因死亡，6例（10.6%）患者发生心血管住院。2例（3.2%）患者报告发生全卒中，5例（8.3%）患者进行永久起搏器植入，1例（1.6%）患者发生心肌梗死。超声心动图评估显示平均压力阶差为[8, 16.5] mmHg，有效瓣口面积为[1.4, 1.9] cm，1例（2%）患者有中度主动脉瓣反流（AR），14例（27%）患者有轻度AR，37例（71%）患者无/微量AR。总共1例患者被诊断为瓣膜血栓形成（2.1%），3例（6.4%）患者出现II期（中度）血流动力学恶化，1例（2.1%）患者出现III期（重度）血流动力学恶化。