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经导管主动脉瓣置换术在二叶式主动脉瓣与三叶式主动脉瓣患者中的长期耐久性比较。

Long-Term Durability of Transcatheter Aortic Valve Prostheses in Patients With Bicuspid Versus Tricuspid Aortic Valve.

机构信息

Department of Cardiology West China Hospital, Sichuan University Chengdu People's Republic of China.

Laboratory of Cardiac Structure and Function, Institute of Cardiovascular Diseases West China Hospital, Sichuan University Chengdu People's Republic of China.

出版信息

J Am Heart Assoc. 2024 Nov 5;13(21):e035772. doi: 10.1161/JAHA.124.035772. Epub 2024 Oct 29.

DOI:10.1161/JAHA.124.035772
PMID:39470054
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11935685/
Abstract

BACKGROUND: Currently, there is a lack of evidence for the long-term bioprosthetic valve durability of patients with bicuspid aortic valve (BAV) following transcatheter aortic valve replacement (TAVR). METHODS AND RESULTS: This study aimed to evaluate hemodynamic outcome, structural valve deterioration, and bioprosthetic valve failure during long-term follow-up after TAVR in patients with BAV versus patients with tricuspid aortic valve (TAV). Patients with BAV and TAV who underwent TAVR between 2012 and 2020, with echocardiography followed for at least 3 years, were included. Baseline characteristics, long-term valve hemodynamic performance, structural valve deterioration, and bioprosthetic valve failure were compared between patients with BAV and TAV. A total of 170 patients with BAV and 145 patients with TAV were included. The mean duration of follow-up for patients with BAV and TAV was 5.2±1.8 and 5.0±1.7 years. No significant differences were observed in the rates of structural valve deterioration and bioprosthetic valve failure between patients with BAV and TAV: structural valve deterioration, BAV 20 (11.8%) versus TAV 16 (11.0%) at last follow-up (=0.861); bioprosthetic valve failure, BAV 3 (1.8%) versus TAV 7 (4.8%) at last follow-up (=0.196). More than moderate intravalvular aortic regurgitation (1.8% versus 4.8%, =0.196) and paravalvular leak (6.5% versus 3.4%, =0.305) were rare in both patients with BAV and patients with TAV. CONCLUSIONS: This study indicated satisfactory long-term valve durability of TAVR in patients with BAV. Comparable hemodynamic outcome, structural valve deterioration, and bioprosthetic valve failure could be achieved in patients with BAV and TAV during long-term follow-up after TAVR.

摘要

背景：目前，关于经导管主动脉瓣置换术（TAVR）后二叶式主动脉瓣（BAV）患者的生物瓣长期耐久性，缺乏相关证据。

方法和结果：本研究旨在评估 TAVR 后 BAV 患者与三叶式主动脉瓣（TAV）患者的血流动力学结果、结构性瓣膜退化和生物瓣失效的长期随访情况。纳入 2012 年至 2020 年期间接受 TAVR 且至少随访 3 年有超声心动图随访的 BAV 和 TAV 患者。比较 BAV 和 TAV 患者的基线特征、长期瓣膜血流动力学性能、结构性瓣膜退化和生物瓣失效。共纳入 170 例 BAV 患者和 145 例 TAV 患者。BAV 和 TAV 患者的中位随访时间分别为 5.2±1.8 和 5.0±1.7 年。BAV 和 TAV 患者的结构性瓣膜退化和生物瓣失效发生率无显著差异：结构性瓣膜退化，BAV 组 20（11.8%）例，TAV 组 16（11.0%）例，末次随访时差异无统计学意义（=0.861）；生物瓣失效，BAV 组 3（1.8%）例，TAV 组 7（4.8%）例，末次随访时差异无统计学意义（=0.196）。两种患者的中重度瓣周反流（1.8%与 4.8%，=0.196）和瓣周漏（6.5%与 3.4%，=0.305）均少见。

结论：本研究表明，TAVR 治疗 BAV 患者具有满意的长期瓣膜耐久性。TAVR 后长期随访，BAV 患者与 TAV 患者的血流动力学结果、结构性瓣膜退化和生物瓣失效相当。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/3451/11935685/070e06929523/JAH3-13-e035772-g004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/3451/11935685/ea51b1660d51/JAH3-13-e035772-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/3451/11935685/91cc2a04cf2f/JAH3-13-e035772-g005.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/3451/11935685/4521d6829083/JAH3-13-e035772-g006.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/3451/11935685/1bfb55f8a9d9/JAH3-13-e035772-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/3451/11935685/070e06929523/JAH3-13-e035772-g004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/3451/11935685/ea51b1660d51/JAH3-13-e035772-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/3451/11935685/91cc2a04cf2f/JAH3-13-e035772-g005.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/3451/11935685/4521d6829083/JAH3-13-e035772-g006.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/3451/11935685/1bfb55f8a9d9/JAH3-13-e035772-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/3451/11935685/070e06929523/JAH3-13-e035772-g004.jpg

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[2]
Transcatheter aortic valve implantation in low-risk tricuspid or bicuspid aortic stenosis: the NOTION-2 trial.

Eur Heart J. 2024-10-5

[3]
Transcatheter or surgical aortic valve implantation: 10-year outcomes of the NOTION trial.

Eur Heart J. 2024-4-1

[4]
Five-Year Outcomes After Bicuspid Aortic Valve Replacement With a Novel Tissue Bioprosthesis.

Ann Thorac Surg. 2024-7

[5]
Mid-term outcomes and hemodynamic performance of transcatheter aortic valve implantation in bicuspid aortic valve stenosis: Insights from the bicuSpid TAvi duraBILITY (STABILITY) registry.

Catheter Cardiovasc Interv. 2023-11

[6]
Long-term durability of self-expanding and balloon-expandable transcatheter aortic valve prostheses: UK TAVI registry.

Catheter Cardiovasc Interv. 2023-4

[7]
Structural Valve Deterioration After Self-Expanding Transcatheter or Surgical Aortic Valve Implantation in Patients at Intermediate or High Risk.

JAMA Cardiol. 2023-2-1

[8]
Transcatheter aortic valve implantation in patients with bicuspid valve morphology: a roadmap towards standardization.

Nat Rev Cardiol. 2023-1

[9]
The 10-year horizon: Survival and structural valve degeneration in first-generation transcatheter aortic valves.

Arch Cardiovasc Dis. 2022

[10]
Computed tomography predictors of structural valve degeneration in patients undergoing transcatheter aortic valve implantation with balloon-expandable prostheses.

Eur Radiol. 2022-9

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