Jia Yuheng, Maznyczka Annette, Boiago Mauro, Khokhar Arif, Tomii Daijiro, Neylon Antoinette, Danthine Pauline, Levesque Thomas, Bamford Paul, Toggweiler Stefan, Moccetti Federico, Piuhola Jarkko, Adamo Marianna, Massussi Mauro, Ielasi Alfonso, Montorfano Matteo, Costa Giulia, Swaans Martin, Overduin Daniël C, Servoz Clément, Gandolfo Caterina, Guðmundsdóttir Ingibjörg Jóna, Salizzoni Stefano, Wykrzykowska Joanna J, van Bergeijk Kees H, Buono Andrea, Hartikainen Tau, Noble Stephane, Mylotte Darren, Brecker Stephen, Thabit Ahmed, Mangieri Antonio, Agostoni Pierfrancesco, Bunc Matjaž, Vanhaverbeke Maarten, Bosmans Johan, Eltchaninoff Hélène, Latib Azeem, Blackman Daniel, Van Mieghem Nicolas M, Feng Yuan, Kim Won-Keun, Pilgrim Thomas, Prendergast Bernard, Tchétché Didier, Chen Mao, De Backer Ole
The Heart Center, Rigshospitalet, Copenhagen, Denmark.
Department of Cardiology, West China Hospital, Chengdu, China.
Catheter Cardiovasc Interv. 2025 Sep;106(3):1746-1757. doi: 10.1002/ccd.31742. Epub 2025 Jul 3.
Data concerning the long-term durability of transcatheter aortic valves (TAVs) in patients with bicuspid aortic stenosis (AS) are lacking.
The study aims to report data on long-term valve durability following transcatheter aortic valve replacement (TAVR) in bicuspid AS.
This multicentre registry included patients who underwent TAVR for bicuspid AS with at least 2-year echocardiographic follow-up. The incidence of structural valve deterioration (SVD), bioprosthetic valve dysfunction (BVD), and bioprosthetic valve failure (BVF) was determined according to Valve Academic Research Consortium (VARC)-3 criteria.
Among 894 patients (mean age: 75.6 years; 39% female), the median echocardiographic follow-up was 48.7 months with a 5-year cumulative incidence of moderate-to-severe SVD, severe SVD, severe BVD, and BVF of 8.1%, 3.2%, 11.4%, and 6.1%, respectively. Younger age (≤ 75 years) was associated with a higher likelihood of reintervention (HR 2.40, log-rank p = 0.04). TAV downsizing was associated with higher rates of moderate-to-severe SVD (HR 3.05, log-rank p < 0.001), severe BVD (HR 2.07, log-rank p = 0.003), and BVF (HR 3.25, log-rank p = 0.002). In the sub-group with small annuli (area ≤ 430 mm), implantation of balloon-expandable TAVs was associated with a higher rate of BVD in comparison with self-expanding TAVs (HR: 3.27, log-rank p = 0.008).
TAVs demonstrated favorable 5-year durability in patients with bicuspid AS, although younger patients were more likely to require valve reintervention. Nominal TAV sizing was associated with better durability outcomes as compared to TAV downsizing. Self-expanding valves were associated with superior hemodynamics in patients with small annuli.
关于经导管主动脉瓣（TAV）在二叶式主动脉瓣狭窄（AS）患者中的长期耐用性的数据尚缺。
本研究旨在报告二叶式AS患者经导管主动脉瓣置换术（TAVR）后瓣膜长期耐用性的数据。
这项多中心注册研究纳入了接受TAVR治疗二叶式AS且至少有2年超声心动图随访的患者。根据瓣膜学术研究联盟（VARC）-3标准确定结构性瓣膜退变（SVD）、生物人工瓣膜功能障碍（BVD）和生物人工瓣膜衰竭（BVF）的发生率。
在894例患者（平均年龄：75.6岁；39%为女性）中，超声心动图的中位随访时间为48.7个月，中度至重度SVD、重度SVD、重度BVD和BVF的5年累积发生率分别为8.1%、3.2%、11.4%和6.1%。年龄较小（≤75岁）与再次干预的可能性较高相关（风险比2.40，对数秩检验p=0.04）。TAV尺寸减小与中度至重度SVD（风险比3.05，对数秩检验p<0.001）、重度BVD（风险比2.07，对数秩检验p=0.003）和BVF（风险比3.25，对数秩检验p=0.002）的发生率较高相关。在小瓣环（面积≤430mm）亚组中，与自膨胀式TAV相比，球囊扩张式TAV植入后的BVD发生率较高（风险比：3.27，对数秩检验p=0.008）。
TAV在二叶式AS患者中显示出良好的5年耐用性，尽管年轻患者更有可能需要瓣膜再次干预。与TAV尺寸减小相比，标称TAV尺寸与更好的耐用性结果相关。自膨胀瓣膜在小瓣环患者中与更好的血流动力学相关。
