Gutierrez Lola, Boiago Mauro, De Biase Chiara, Oliva Omar, Laforgia Pietro, Feliachi Souheib, Beneduce Alessandro, Dumonteil Nicolas, Tchetche Didier
Groupe Cardiovasculaire Interventionnel (GCVI), Clinique Pasteur, 31300 Toulouse, France.
J Clin Med. 2023 Nov 14;12(22):7074. doi: 10.3390/jcm12227074.
Bicuspid aortic valve (BAV) is the most common congenital heart disease, with a prevalence of 1-2% and occurring in >20% of octogenarians referred for aortic valve replacement. However, BAV patients have been systematically excluded from pivotal randomized trials. Since TAVI indications are moving toward low-risk patients, an increase in the number of BAV patients who undergo TAVI is expected. BAV represents a challenge due to its unique morphological features (raphe, extreme asymmetrical valve calcifications, cusp asymmetry and aortopathy) and the lack of consensus about the accurate sizing method. The role of multi-slice computed tomography (MSCT) in the planification of the TAVI procedure is well-established, being useful to define the optimal valve sizing and the implantation strategy. New-generation devices, more experience of the operators and better planification of the procedure have been associated with similar clinical outcomes in bicuspid and tricuspid patients undergoing TAVI.
二叶式主动脉瓣(BAV)是最常见的先天性心脏病,患病率为1%-2%,在接受主动脉瓣置换术的80岁以上老人中,其发病率超过20%。然而,BAV患者已被系统性地排除在关键随机试验之外。由于经导管主动脉瓣植入术(TAVI)的适应症正朝着低风险患者发展,预计接受TAVI的BAV患者数量将会增加。BAV因其独特的形态特征(嵴、极度不对称的瓣膜钙化、瓣叶不对称和主动脉病变)以及缺乏关于准确尺寸测量方法的共识而构成挑战。多层计算机断层扫描(MSCT)在TAVI手术规划中的作用已得到充分确立,有助于确定最佳瓣膜尺寸和植入策略。新一代设备、操作者更丰富的经验以及更好的手术规划,已使接受TAVI的二叶式和三叶式患者获得了相似的临床结果。
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