Jia Yuheng, Khokhar Arif A, Pilgrim Thomas, Costa Giuliano, Mylotte Darren, Sammartino Sofia, Tomii Daijiro, Fosbøl Emil, Tamburino Corrado, Kofoed Klaus Fuglsang, Barbanti Marco, Windecker Stephan, Chen Mao, De Backer Ole
The Heart Center, Rigshospitalet, Copenhagen, Denmark.
Department of Cardiology, West China Hospital, Chengdu, China.
Clin Res Cardiol. 2025 Mar;114(3):375-384. doi: 10.1007/s00392-024-02545-9. Epub 2024 Sep 19.
Patients undergoing transcatheter aortic valve implantation (TAVI) for bicuspid aortic stenosis (AS) frequently present with ascending aortic (AAo) dilatation which is left untreated. The objective of this study was to study the natural progression and underlying mechanisms of AAo dilatation after TAVI for bicuspid AS.
Patients with a native bicuspid AS and a baseline AAo maximum diameter > 40 mm treated by TAVI and in whom post-TAVI computed tomography (CT) scans beyond 1 year were available were included. AAo dilatation was deemed to be either continuous (≥ 2 mm increase) or stable (< 2 mm increase or decrease). Uni- and multivariate logistic regression analysis was utilized in order to identify factors associated with continuous AAo dilatation post-TAVI.
A total of 61 patients with a mean AAo maximum diameter of 45.6 ± 3.9 mm at baseline were evaluated. At a median follow-up of 2.9 years, AAo dimensions remained stable in 85% of patients. Continuous AAo dilatation was observed in 15% of patients at a rate of 1.4 mm/year. Factors associated with continuous AAo dilatation were raphe length/annulus mean diameter ratio (OR 4.09, 95% CI [1.40-16.7], p = 0.022), TAV eccentricity at the leaflet outflow level (OR 2.11, 95%CI [1.12-4.53], p = 0.031) and maximum transprosthetic gradient (OR 1.30, 95%CI [0.99-1.73], p = 0.058).
Ascending aortic dilatation in patients undergoing TAVI for bicuspid AS remains stable in the majority of patients. Factors influencing TAV stent frame geometry and function were identified to be associated with continuous AAo dilatation after TAVI; this should be confirmed in future larger cohort studies.
接受经导管主动脉瓣植入术（TAVI）治疗二叶式主动脉瓣狭窄（AS）的患者常伴有升主动脉（AAo）扩张，但未得到治疗。本研究的目的是探讨TAVI治疗二叶式AS后AAo扩张的自然进展及潜在机制。
纳入接受TAVI治疗的原发性二叶式AS患者，基线时AAo最大直径>40 mm，且有术后1年以上的计算机断层扫描（CT）图像。AAo扩张被定义为持续扩张（增加≥2 mm）或稳定（增加或减少<2 mm）。采用单因素和多因素逻辑回归分析，以确定与TAVI术后AAo持续扩张相关的因素。
共评估61例患者，基线时AAo平均最大直径为45.6±3.9 mm。中位随访2.9年时，85%的患者AAo尺寸保持稳定。15%的患者出现AAo持续扩张，扩张速率为1.4 mm/年。与AAo持续扩张相关的因素包括嵴长度/瓣环平均直径比（OR 4.09，95%CI [1.40-16.7]，p = 0.022）、瓣叶流出道水平的TAV偏心度（OR 2.11，95%CI [1.12-4.53]，p = 0.031）和最大跨瓣压差（OR 1.30，95%CI [0.99-1.73]，p = 0.058）。
接受TAVI治疗二叶式AS的患者中，大多数患者的升主动脉扩张保持稳定。影响TAV支架框架几何形状和功能的因素被确定与TAVI术后AAo持续扩张相关；这一点应在未来更大规模的队列研究中得到证实。
