Outcomes in Transcatheter Aortic Valve Replacement for Bicuspid Versus Tricuspid Aortic Valve Stenosis

JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY

卷:69

Article

Yoon, Sung-Han¹  Bleiziffer, Sabine²  De Backer, Ole³  Delgado, Victoria⁴  Arai, Takahide⁵  Ziegelmueller, Johannes²  Barbanti, Marco⁶  Sharma, Rahul¹  Perlman, Gidon Y.⁷  Khalique, Omar K.⁸  Holy, Erik W.^9,10  Saraf, Smriti¹¹  Deuschl, Florian¹²  Fujita, Buntaro¹³  Ruile, Philipp¹⁴  Neumann, Franz-Josef¹⁵  Pache, Gregor¹⁵  Takahashi, Masao¹⁶  Kaneko, Hidehiro¹⁷  Schmidt, Tobias¹⁸  Ohno, Yohei⁷  Schofer, Niklas¹²  Kong, William K. F.^4,19  Tay, Edgar¹⁹  Sugiyama, Daisuke²⁰  Kawamori, Hiroyuki¹  Maeno, Yoshio¹  Abramowitz, Yigal¹  Chakravarty, Tarun¹  Nakamura, Mamoo¹  Kuwata, Shingo²¹  Yong, Gerald²²  Kao, Hsien-Li²³  Lee, Michael²⁴  Kim, Hyo-Soo^25,26  Modine, Thomas²⁷  Wong, S. Chiu²⁸  Bedgoni, Francesco²⁹  Testa, Luca²⁹  Teiger, Emmanuel¹⁶  Butter, Christian¹⁷  Ensminger, Stephan M.¹³  Schaefer, Ulrich¹²  Dvir, Danny⁷  Blanke, Philipp⁷  Leipsic, Jonathon⁷  Nietlispach, Fabian²¹  Abdel-Wahab, Mohamed^9,10  Chevalier, Bernard⁵  Tamburino, Corrado⁶  Hildick-Smith, David¹¹  Whisenant, Brian K.³⁰  Park, Seung-Jung³¹  Colombo, Antonio^32,33,34  Latib, Azeem^32,33,34  Kodali, Susheel K.⁸  Bax, Jeroen J.⁴  Sondergaard, Lars³  Webb, John G.⁵  Lefevre, Thierry⁵  Leon, Martin B.⁸  Makkar, Raj¹ 

[1] Cedars Sinai Heart Inst, Dept Intervent Cardiol, 8700 Beverly Blvd, Los Angeles, CA 90048 USA

[2] German Heart Ctr Munich, Clin Cardiovasc Surg, Munich, Germany

[3] Univ Hosp, Rigshosp, Heart Ctr, Copenhagen, Denmark

[4] Leiden Univ, Med Ctr, Dept Cardiol, Leiden, Netherlands

[5] Hop Prive Jacques Cartier, Inst Cardiovasc Paris Sud, Gen Sante, Massy, France

[6] Univ Catania, Ferrarotto Hosp, Div Cardiol, Catania, Italy

[7] Univ British Columbia, St Pauls Hosp, Dept Cardiol, Vancouver, BC, Canada

[8] Columbia Univ, Med Ctr, New York Presbyterian Hosp, New York, NY USA

[9] Univ Kiel, Acad Teaching Hosp, Segeberger Kliniken GmbH, Heart Ctr, Hamburg, Germany

[10] Univ Kiel, Acad Teaching Hosp, Segeberger Kliniken GmbH, Heart Ctr, Lubeck, Germany

[11] Brighton & Sussex Univ Hosp NHS Trust, Sussex Cardiac Ctr, Brighton, E Sussex, England

[12] Univ Heart Ctr, Dept Gen & Intervent Cardiol, Hamburg, Germany

[13] Ruhr Univ Bochum, Dept Thorac & Cardiovasc Surg, Heart & Diabet Ctr NRW, Bad Oeynhausen, Germany

[14] Univ Heart Ctr Freiburg Bad Krozingen, Dept Cardiol & Angiol 2, Bad Krozingen, Germany

[15] Univ Freiburg, Sect Cardiovasc Radiol, Dept Radiol, Bad Krozingen, Germany

[16] Henri Mondor Univ Hosp, Dept Cardiol, Creteil, France

[17] Heart Ctr Brandenburg Bernau, Bernau, Germany

[18] Asklepios Klink St Georg, Dept Cardiol, Hamburg, Germany

[19] Natl Univ Heart Ctr, Dept Cardiol, Singapore, Singapore

[20] Keio Univ, Dept Prevent Med & Publ Hlth, Tokyo, Japan

[21] Univ Zurich Hosp, Univ Heart Ctr, Zurich, Switzerland

[22] Royal Perth Hosp, Div Cardiol, Perth, WA, Australia

[23] Natl Taiwan Univ Hosp, Dept Internal Med, Taipei, Taiwan

[24] Queen Elizabeth Hosp, Div Cardiol, Kowloon, Hong Kong, Peoples R China

[25] Seoul Natl Univ Hosp, Dept Internal Med, Seoul, South Korea

[26] Seoul Natl Univ Hosp, Cardiovasc Ctr, Seoul, South Korea

[27] Hosp Cardiol, Dept Cardiovasc Surg, Lille, France

[28] New York Presbyterian Hosp, Weil Cornell Med, Greenberg Div Cardiol, New York, NY USA

[29] IRCCS Pol San Donato, Dept Cardiol, Milan, Italy

[30] Intermt Heart Inst, Div Cardiovasc Dis, Salt Lake City, UT USA

[31] Univ Ulsan, Asan Med Ctr, Div Cardiol, Seoul, South Korea

[32] EMO GVM Ctr Cuore Columbus, Intervent Cardiol Unit, Milan, Italy

[33] Ist Sci San Raffaele, Milan, Italy

[34] Osped San Raffaele, Milan, Italy

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

DOI  :  10.1016/j.jacc.2017.03.017

来源: Elsevier

【 摘 要 】

BACKGROUND Transcatheter aortic valve replacement (TAVR) is being increasingly performed in patients with bicuspid aortic valve stenosis (AS). OBJECTIVES This study sought to compare the procedural and clinical outcomes in patients with bicuspid versus tricuspid AS from the Bicuspid AS TAVR multicenter registry. METHODS Outcomes of 561 patients with bicuspid AS and 4,546 patients with tricuspid AS were compared after propensity score matching, assembling 546 pairs of patients with similar baseline characteristics. Procedural and clinical outcomes were recorded according to Valve Academic Research Consortium-2 criteria. RESULTS Compared with patients with tricuspid AS, patients with bicuspid AS had more frequent conversion to surgery (2.0% vs. 0.2%; p = 0.006) and a significantly lower device success rate (85.3% vs. 91.4%; p = 0.002). Early-generation devices were implanted in 320 patients with bicuspid and 321 patients with tricuspid AS, whereas new-generation devices were implanted in 226 and 225 patients with bicuspid and tricuspid AS, respectively. Within the group receiving early-generation devices, bicuspid AS had more frequent aortic root injury (4.5% vs. 0.0%; p = 0.015) when receiving the balloon-expanding device, and moderate-to-severe paravalvular leak (19.4% vs. 10.5%; p = 0.02) when receiving the self-expanding device. Among patients with new-generation devices, however, procedural results were comparable across different prostheses. The cumulative all-cause mortality rates at 2 years were comparable between bicuspid and tricuspid AS (17.2% vs. 19.4%; p = 0.28). CONCLUSIONS Compared with tricuspid AS, TAVR in bicuspid AS was associated with a similar prognosis, but lower device success rate. Procedural differences were observed in patients treated with the early-generation devices, whereas no differences were observed with the new-generation devices. (J Am Coll Cardiol 2017;69: 2579-89) (C) 2017 The Authors. Published by Elsevier on behalf of the American College of Cardiology Foundation. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

【 授权许可】

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