Groupe CardioVasculaire Interventionnel, Clinique Pasteur, Toulouse, France.
Catheter Cardiovasc Interv. 2024 May;103(6):1004-1014. doi: 10.1002/ccd.31041. Epub 2024 Apr 5.
Bicuspid aortic valve (BAV) stenosis is a complex anatomical scenario for transcatheter aortic valve implantation (TAVI). Favorable short-term clinical outcomes have been reported with TAVI in this setting, but long-term data are scarce.
We retrospectively included, in a single-center registry, patients with BAV stenosis who underwent TAVI before 2020. We compared patients treated with self-expanding valves (SEV) versus balloon-expandable valves (BEV). The primary endpoint was a composite of all-cause mortality, stroke and need for aortic valve (AV) reintervention at 3 years. Secondary endpoints included each component of the primary endpoint, cardiovascular mortality, permanent pacemaker implantation (PPI) rate, mean gradient and ≥moderate paravalvular leak (PVL) rate.
A total of 150 consecutive patients (SEV = 83, BEV = 67) were included. No significant differences were reported between SEV and BEV groups for the primary composite endpoint (SEV 35.9% vs. BEV 32%, p = 0.66), neither for clinical secondary endpoints (all-cause mortality SEV 28.1% vs. BEV 28%, p = 0.988; cardiovascular mortality SEV 14.1% vs. BEV 20%, p = 0.399; stroke SEV 12.5% vs. BEV 6%, p = 0.342; need for AV reintervention SEV 0% vs. BEV 0%; PPI SEV 28.1% vs. BEV 24%, p = 0.620). A lower mean gradient persisted up to 3 years in the SEV group (SEV 8.8 ± 3.8 mmHg vs. BEV 10.7 ± 3.2 mmHg, p = 0.063), while no significant difference was found in the rate of ≥ moderate PVL (SEV 3/30 vs. BEV 0/25, p = 0.242).
In this single center registry, we observed favorable 3-year clinical outcomes in nonselected BAV patients treated with different generation devices, without significant differences between patients receiving SEV or BEV.
二叶式主动脉瓣（BAV）狭窄是经导管主动脉瓣植入术（TAVI）的复杂解剖学情况。在这种情况下，TAVI 已报道有良好的短期临床结果，但长期数据稀缺。
我们在单中心登记处回顾性纳入了 2020 年前接受 TAVI 治疗的 BAV 狭窄患者。我们比较了使用自膨式瓣膜（SEV）和球囊扩张式瓣膜（BEV）治疗的患者。主要终点是 3 年时全因死亡率、卒中和主动脉瓣（AV）再介入的复合终点。次要终点包括主要终点的各个组成部分、心血管死亡率、永久性起搏器植入（PPI）率、平均梯度和≥中度瓣周漏（PVL）率。
共纳入 150 例连续患者（SEV=83 例，BEV=67 例）。SEV 组和 BEV 组在主要复合终点（SEV 35.9% vs. BEV 32%，p=0.66）和临床次要终点（全因死亡率 SEV 28.1% vs. BEV 28%，p=0.988；心血管死亡率 SEV 14.1% vs. BEV 20%，p=0.399；卒 SEV 12.5% vs. BEV 6%，p=0.342；AV 再介入需要 SEV 0% vs. BEV 0%；PPI SEV 28.1% vs. BEV 24%，p=0.620）方面均无显著差异。SEV 组的平均梯度在 3 年内持续较低（SEV 8.8±3.8mmHg vs. BEV 10.7±3.2mmHg，p=0.063），而≥中度 PVL 的发生率无显著差异（SEV 3/30 例 vs. BEV 0/25 例，p=0.242）。
在这个单中心登记处，我们观察到在非选择性 BAV 患者中，使用不同代设备治疗有良好的 3 年临床结果，SEV 组和 BEV 组之间无显著差异。
