综述文章:用于二叶式主动脉解剖结构经导管主动脉瓣置换术(TAVI)的当代经导管心脏瓣膜

Review Article: Contemporary Transcatheter Heart Valves for TAVI in Bicuspid Aortic Anatomy.

作者信息

Simopoulou Chrysavgi, Oliva Omar, Cesario Vincenzo, Dumonteil Nicolas, Tchetche Didier, De Biase Chiara

机构信息

Groupe Cardio-Vasculaire Interventionnel, Clinique Pasteur, 45, Avenue de Lombez, 31000 Toulouse, France.

出版信息

J Clin Med. 2025 Apr 20;14(8):2838. doi: 10.3390/jcm14082838.

Abstract

Bicuspid aortic valve (BAV) is the most common congenital heart disease, affecting 0.5-2% of the population and often leading to early aortic valve degeneration. While surgical aortic valve replacement (SAVR) remains the gold standard for treating severe bicuspid aortic stenosis (AS), transcatheter aortic valve implantation (TAVI) is emerging as a viable alternative in selected BAV anatomies. Initial experiences with first-generation transcatheter heart valves (THVs) showed the feasibility of this technique, but were associated with lower device success rates and higher complications, such as paravalvular leak (PVL) and pacemaker implantation. Advancements in second- and third- generation THVs, together with better pre-procedural imaging assessment and growing operator experience, have significantly enhanced TAVI outcomes in BAV patients, with results now comparable to those seen in tricuspid aortic valves (TAVs). Proper patient selection, pre-procedural sizing, and device implantation are key to improving TAVI success in BAV. Recent registry data on contemporary THV platforms demonstrate improved procedural success, hemodynamic performance, and the safety of TAVI in BAV. However, higher rates of PVL, pacemaker implantation, and strokes remain concerns. Ongoing advancements in THV design and procedural techniques will further enhance outcomes for this challenging population. Up to the present, there are no dedicated THVs for BAV, but the latest-generation THVs offer promising results.

摘要

二叶式主动脉瓣(BAV)是最常见的先天性心脏病,影响着0.5%-2%的人群,且常导致主动脉瓣早期退变。虽然外科主动脉瓣置换术(SAVR)仍是治疗重度二叶式主动脉瓣狭窄(AS)的金标准,但经导管主动脉瓣植入术(TAVI)在特定的BAV解剖结构中正在成为一种可行的替代方案。第一代经导管心脏瓣膜(THV)的初步经验显示了该技术的可行性,但与较低的器械成功率和较高的并发症相关,如瓣周漏(PVL)和起搏器植入。第二代和第三代THV的进展,加上更好的术前影像评估和术者经验的增加,显著改善了BAV患者的TAVI结果,目前的结果与三尖瓣主动脉瓣(TAV)患者的结果相当。正确的患者选择、术前尺寸测量和器械植入是提高BAV患者TAVI成功率的关键。当代THV平台的最新注册数据显示,BAV患者的TAVI手术成功率、血流动力学性能和安全性均有所改善。然而,较高的PVL发生率、起搏器植入率和中风发生率仍然令人担忧。THV设计和手术技术的持续进步将进一步改善这一具有挑战性人群的治疗结果。到目前为止,尚无专门用于BAV的THV,但最新一代的THV已显示出有前景的结果。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/0b4b/12027816/2fc85fb53bf8/jcm-14-02838-g001.jpg

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