A Bicuspid Aortic Valve Imaging Classification for the TAVR Era

JACC-CARDIOVASCULAR IMAGING

卷:9

Article

Jilaihawi, Hasan¹  Chen, Mao²  Webb, John³  Himbert, Dominique⁴  Ruiz, Carlos E.⁵  Rodes-Cabau, Josep⁶  Pache, Gregor⁷  Colombo, Antonio^8,9  Nickenig, Georg¹⁰  Lee, Michael¹¹  Tamburino, Corrado¹²  Sievert, Horst¹³  Abramowitz, Yigal¹⁴  Tarantini, Giuseppe¹⁵  Alqoofi, Faisal¹⁶  Chakravarty, Tarun¹⁴  Kashif, Mohammad¹⁴  Takahashi, Nobuyuki¹⁴  Kazuno, Yoshio¹⁴  Maeno, Yoshio¹⁴  Kawamori, Hiroyuki¹⁴  Chieffo, Alaide^8,9  Blanke, Philipp^3,7  Dvir, Danny³  Ribeiro, Henrique Barbosa⁶  Feng, Yuan²  Zhao, Zhen-Gang²  Sinning, Jan-Malte¹⁰  Kliger, Chad⁵  Giustino, Gennaro^8,9  Pajerski, Basia³  Imme, Sebastiano¹²  Grube, Eberhard¹⁰  Leipsic, Jonathon³  Vahanian, Alec⁴  Michev, Iassen^8,9  Jelnin, Vladimir⁵  Latib, Azeem^8,9  Cheng, Wen¹⁴  Makkar, Raj¹⁴ 

[1] NYU, Langone Med Ctr, Dept Cardiol & Cardiothorac Surg, New York, NY USA

[2] Sichuan Univ, West China Hosp, Dept Cardiol, Chengdu, Peoples R China

[3] St Pauls Hosp, Vancouver, BC, Canada

[4] Bichat Claude Bernard Hosp, AP HP, Dept Cardiol, Paris, France

[5] Lenox Hill Heart & Vasc Inst New York, New York, NY USA

[6] Univ Laval, Quebec Heart & Lung Inst, Quebec City, PQ, Canada

[7] Univ Hosp Freiburg, Freiburg, Germany

[8] EMO GVM Ctr Cuore Columbus, Milan, Italy

[9] Ist Sci San Raffaele, Milan, Italy

[10] Univ Bonn, Dept Internal Med & Cardiol Pneumol, Bonn, Germany

[11] Queen Elizabeth Hosp, Div Cardiol, Dept Med, Kowloon, Hong Kong, Peoples R China

[12] Univ Catania, Ferrarotto Hosp, Catania, Italy

[13] CardioVasc Ctr Frankfurt, Dept Cardiol & Vasc Med, Frankfurt, Germany

[14] Cedars Sinai Heart Inst, Suite A3600,127 South San Vicente Blvd, Los Angeles, CA 90037 USA

[15] Univ Padua, Padua, Italy

[16] Univ Calgary, Calgary, AB, Canada

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

DOI  :  10.1016/j.jcmg.2015.12.022

来源: Elsevier

【 摘 要 】

OBJECTIVES This study sought to evaluate transcatheter aortic valve replacement (TAVR) in bicuspid aortic valve (BAV) aortic stenosis (AS), with a particular emphasis on TAVR-directed bicuspid aortic valve imaging (BAVi) of morphological classification. BACKGROUND TAVR has been used to treat BAV-AS but with heterogeneous outcomes and uncertainty regarding the relevance of morphology. METHODS In 14 centers in the United States, Canada, Europe, and Asia, 130 BAV-AS patients underwent TAVR. Baseline cardiac computed tomography (CT) was analyzed by a dedicated Corelab. Outcomes were assessed in line with Valve Academic Research Consortium criteria. RESULTS Bicommissural BAV (vs. tricommissural) accounted for 68.9% of those treated in North America, 88.9% in Europe, and 95.5% in Asia (p = 0.003). For bicommissural bicuspids, non-raphe type (vs. raphe type) BAV accounted for 11.9% of those treated in North America, 9.4% in Europe, and 61.9% in Asia (p < 0.001). Overall rates of 30-day mortality (3.8%) and cerebrovascular events (3.2%) were favorable and similar among anatomical subsets. The rate of new permanent pacemaker insertion was high (26.2%) and similar between balloon-expandable (BE) and self expanding (SE) designs (BE: 25.5% vs. SE: 26.9%; p = 0.83); there was a trend to greater permanent pacemaker insertion in BE TAVR in the presence of coronary cusp fusion BAV morphology. Paravalvular aortic regurgitation (PAR) moderate was 18.1% overall but lower at 11.5% in those with pre-procedural CT. In the absence of pre-procedural CT, there was an excess of PAR in BE TAVR that was not the case in those with a pre-procedural CT; SE TAVR required more post-dilation. Predictors of PAR included intercommissural distance for bicommissural bicuspids (odd ratio [OR]: 1.37; 95% confidence interval [CI]: 1.02 to 1.84; p = 0.036) and lack of a baseline CT for annular measurement (OR: 3.03; 95% CI: 1.20 to 7.69; p = 0.018). CONCLUSIONS In this multicenter study, TAVR achieved favorable outcomes in patients with pre-procedural CT, with the exception of high permanent pacemaker rates for all devices and shapes. (C) 2016 by the American College of Cardiology Foundation.

【 授权许可】

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