Khalifa Mostafa A, Hashim Hashim Talib, Shimal Aya Ahmed, Riyas Mohamed Fathima Raahima, Ragunathan Srinithi, Al Sakini Ahmed Sermed, Elbadawi Mohamed H, Irfan Mohammed Rushdhi, Moqbel Ibrahim, Almualed Marwah Mohammed, Al-Ghuraibawi Mohammedbaqer, Al-Aboudi Batool S
Faculty of Medicine, Cairo University, Cairo, Egypt.
College of Medicine, University of Warith Al-Anbiyaa, Karbala, Iraq.
Front Cardiovasc Med. 2025 May 30;12:1572251. doi: 10.3389/fcvm.2025.1572251. eCollection 2025.
While Transcatheter Aortic Valve Replacement (TAVR) is now a standard treatment for severe aortic stenosis, its use in patients with quadricuspid aortic valves (QAV) presents unique challenges. This review analyzes current evidence to guide clinicians in managing aortic stenosis in this complex valve morphology.
Following PRISMA guidelines, a comprehensive literature search was conducted across multiple databases up to August 15, 2024. A random-effects model was used for meta-analysis, focusing on 30-day mortality and procedural success, with secondary outcomes including paravalvular leak incidence, pacemaker insertion, hemodynamic changes, and NYHA functional class improvement.
A total of 11 case reports/series were analyzed, involving 17 adult patients with QAV. Participants had a mean age of 73.80 ± 5.07 years. The mean left ventricular ejection fraction was 41.6%, and the mean annulus area was 595.5 mm. Most patients (64.7%) underwent transfemoral procedures, with nearly 70% receiving a J-valve or Edwards SAPIEN 3 device. All procedures were largely successful, though 29.4% experienced leakage or regurgitation. Aortic pre-dilation was done in 41.2% of cases. The mean procedural duration was 102 min, with a fluoroscopic duration of 15 min. No patients experienced aortic post-dilation, and one (5.8%) had an atrioventricular block within 30 days post-procedure.
TAVR is an effective and growing treatment for high-risk patients with aortic valve disease, including those with QAV. While it has high success rates and challenges (i.e., post-operatively). Future studies should focus on long-term valve durability.
虽然经导管主动脉瓣置换术（TAVR）目前是重度主动脉瓣狭窄的标准治疗方法，但在四叶式主动脉瓣（QAV）患者中使用该方法存在独特挑战。本综述分析现有证据，以指导临床医生处理这种复杂瓣膜形态下的主动脉瓣狭窄。
按照PRISMA指南，截至2024年8月15日在多个数据库进行了全面的文献检索。采用随机效应模型进行荟萃分析，重点关注30天死亡率和手术成功率，次要结局包括瓣周漏发生率、起搏器植入、血流动力学变化和纽约心脏协会（NYHA）心功能分级改善情况。
共分析了11篇病例报告/系列研究，涉及17例成年QAV患者。参与者的平均年龄为73.80±5.07岁。平均左心室射血分数为41.6%，平均瓣环面积为595.5平方毫米。大多数患者（64.7%）接受经股动脉手术，近70%的患者接受J瓣膜或爱德华SAPIEN 3装置。所有手术在很大程度上都取得了成功，不过29.4%的患者出现了渗漏或反流。41.2%的病例进行了主动脉预扩张。平均手术时长为102分钟，透视时长为15分钟。没有患者进行主动脉后扩张，1例（5.8%）患者在术后30天内发生房室传导阻滞。
TAVR对于包括QAV患者在内的高危主动脉瓣疾病患者是一种有效且应用日益广泛的治疗方法。虽然其成功率较高，但也存在挑战（如术后）。未来的研究应聚焦于瓣膜的长期耐用性。
