Transcatheter Aortic Valve Replacement in Bicuspid Aortic Valve Disease

JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY

卷:64

Article

Mylotte, Darren^1,2  Lefevre, Thierry³  Sondergaard, Lars⁴  Watanabe, Yusuke³  Modine, Thomas⁵  Dvir, Danny⁶  Bosmans, Johan⁷  Tchetche, Didier⁸  Kornowski, Ran^9,10  Sinning, Jan-Malte^2,3  Theriault-Lauzier, Pascal²  O'Sullivan, Crochan J.¹²  Barbanti, Marco¹³  Debry, Nicolas⁵  Buithieu, Jean²  Codner, Pablo^9,10  Dorfmeister, Magdalena¹⁴  Martucci, Giuseppe²  Nickenig, Georg¹¹  Wenaweser, Peter¹²  Tamburino, Corrado¹³  Grube, Eberhard¹¹  Webb, John G.⁶  Windecker, Stephan¹²  Lange, Ruediger¹⁴  Piazza, Nicolo^2,14 

[1] Univ Hosp Galway, Dept Cardiol, Galway, Ireland

[2] McGill Univ, Ctr Hlth, Div Cardiol, Montreal, PQ H3A 1A1, Canada

[3] Hop Jacques Cartier, Dept Intervent Cardiol, Massy, France

[4] Rigshosp, Dept Cardiol, DK-2100 Copenhagen, Denmark

[5] Hop Cardiol, Dept Cardiovasc Surg, F-59037 Lille, France

[6] St Pauls Hosp, Dept Cardiol, Vancouver, BC V6Z 1Y6, Canada

[7] Univ Antwerp Hosp, Dept Cardiol, Antwerp, Belgium

[8] Clin Pasteur, Dept Intervent Cardiol, Toulouse, France

[9] Rabin Med Ctr, Dept Cardiol, Tel Aviv, Israel

[10] Tel Aviv Univ, IL-69978 Tel Aviv, Israel

[11] Univ Bonn, Univ Klinikum Bonn, Dept Cardiol, Bonn, Germany

[12] Univ Hosp Bern, Dept Cardiol, CH-3010 Bern, Switzerland

[13] Univ Catania, Ferrarotto Hosp, Dept Cardiol, Catania, Italy

[14] German Heart Ctr, Dept Cardiovasc Surg, Munich, Germany

关键词: aortic stenosis;    aortic valve replacement;    bicuspid aortic valve;    transcatheter aortic valve implantation;    transcatheter aortic valve replacement;   

DOI  :  10.1016/j.jacc.2014.09.039

来源: Elsevier

【 摘 要 】

BACKGROUND Limited information exists describing the results of transcatheter aortic valve (TAV) replacement in patients with bicuspid aortic valve (BAV) disease (TAV-in-BAV). OBJECTIVES This study sought to evaluate clinical outcomes of a large cohort of patients undergoing TAV-in-BAV. METHODS We retrospectively collected baseline characteristics, procedural data, and clinical follow-up findings from 12 centers in Europe and Canada that had performed TAV-in-BAV. RESULTS A total of 139 patients underwent TAV-in-BAV with the balloon-expandable transcatheter heart valve (THV) (n 48) or self-expandable THV (n 91) systems. Patient mean age and Society of Thoracic Surgeons predicted risk of mortality scores were 78.0 8.9 years and 4.9 3.4%, respectively. BAV stenosis occurred in 65.5%, regurgitation in 0.7%, and mixed disease in 33.8% of patients. Incidence of type 0 BAV was 26.7%; type 1 BAV was 68.3%; and type 2 BAV was 5.0%. Multislice computed tomography (MSCT)-based TAV sizing was used in 63.5% of patients (77.1% balloon-expandable THV vs. 56.0% self-expandable THV, p 0.02). Procedural mortality was 3.6%, with TAV embolization in 2.2% and conversion to surgery in 2.2%. The mean aortic gradient decreased from 48.7 16.5 mm Hg to 11.4 9.9 mm Hg (p < 0.0001). Post-implantation aortic regurgitation (AR) grade $ 2 occurred in 28.4% (19.6% balloon-expandable THV vs. 32.2% self-expandable THV, p 0.11) but was prevalent in only 17.4% when MSCT-based TAV sizing was performed (16.7% balloon-expandable THV vs. 17.6% self-expandable THV, p 0.99). MSCT sizing was associated with reduced AR on multivariate analysis (odds ratio [ OR]: 0.19, 95% confidence intervals [ CI]: 0.08 to 0.45; p < 0.0001). Thirty-day device safety, success, and efficacy were noted in 79.1%, 89.9%, and 84.9% of patients, respectively. One-year mortality was 17.5%. Major vascular complications were associated with increased 1-year mortality (OR: 5.66, 95% CI: 1.21 to 26.43; p 0.03). CONCLUSIONS TAV-in-BAV is feasible with encouraging short-and intermediate-term clinical outcomes. Importantly, a high incidence of post-implantation AR is observed, which appears to be mitigated by MSCT-based TAV sizing. Given the suboptimal echocardiographic results, further study is required to evaluate long-term efficacy. (J Am Coll Cardiol 2014; 64: 2330-9) c 2014 by the American College of Cardiology Foundation.

【 授权许可】

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