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Войти в исследования Circulation. Cardiovascular interventions · 2013
Transcatheter aortic valve implantation for patients with severe bicuspid aortic valve stenosis.
СтатьяНазвание и аннотация: Перевод пока не подготовлен
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Hayashida Kentaro, Bouvier Erik, Lefèvre Thierry, Chevalier Bernard, Hovasse Thomas, Romano Mauro, Garot Philippe, Watanabe Yusuke, Farge Arnaud, Donzeau-Gouge Patrick, Cormier Bertrand, Morice Marie-Claude
Аннотация
BACKGROUND: Bicuspid aortic valve (BAV) is regarded as a relative contraindication to transcatheter aortic valve implantation attributable to the risk of uneven expansion of the bioprosthesis. The purpose of this study was to evaluate the efficacy and safety of transcatheter aortic valve implantation in patients with BAV.
METHODS AND RESULTS: Of 470 patients included in our prospective transcatheter aortic valve implantation database (October 2006-January 2012), 229 consecutive patients undergoing both echocardiography and multidetector computed tomography were analyzed. We compared clinical outcomes in patients with vs patients without BAV. In this series of 229 patients, BAV was detected by multidetector computed tomography in 21 patients (9.2%). BAV was identified by transthoracic and transoesophageal echocardiography in only 9 of these 21 patients. Patients were 83.1±6.6 years old, and European system for cardiac operative risk evaluation score was 20.0%±11.4%. The BAV group was similar to the non-BAV group except for diabetes mellitus (4.8% vs 24.0%; P=0.05). The aortic annulus diameter in BAV patients was not significantly larger by multidetector computed tomography (24.7±3.0 vs 23.7±1.9 mm; P=0.07). The CoreValve was used more frequently in the BAV group (47.6% vs 16.3%; P=0.002). There was no significant difference in device success (100% vs 92.8%; P=0.37), risk of annulus rupture (0% vs 1.4%; P=1.00), or valve migration (0% vs 1.4%; P=1.00) in BAV patients compared with non-BAV patients. Post-procedural mean gradient (10.0±3.4 vs 9.7±4.1 mm Hg; P=0.58), aortic regurgitation ≥2 of 4 (19.0% vs 14.9%; P=0.54), 30-day mortality (4.8% vs 8.2%; P=1.00), and 30-day combined safety end point (14.3% vs 13.5%; P=1.00) were also similar in both groups.
CONCLUSIONS: In selected BAV patients, transcatheter aortic valve implantation may be associated with low complication rate, efficacy, and acceptable outcomes similar to those in non-BAV patients.
METHODS AND RESULTS: Of 470 patients included in our prospective transcatheter aortic valve implantation database (October 2006-January 2012), 229 consecutive patients undergoing both echocardiography and multidetector computed tomography were analyzed. We compared clinical outcomes in patients with vs patients without BAV. In this series of 229 patients, BAV was detected by multidetector computed tomography in 21 patients (9.2%). BAV was identified by transthoracic and transoesophageal echocardiography in only 9 of these 21 patients. Patients were 83.1±6.6 years old, and European system for cardiac operative risk evaluation score was 20.0%±11.4%. The BAV group was similar to the non-BAV group except for diabetes mellitus (4.8% vs 24.0%; P=0.05). The aortic annulus diameter in BAV patients was not significantly larger by multidetector computed tomography (24.7±3.0 vs 23.7±1.9 mm; P=0.07). The CoreValve was used more frequently in the BAV group (47.6% vs 16.3%; P=0.002). There was no significant difference in device success (100% vs 92.8%; P=0.37), risk of annulus rupture (0% vs 1.4%; P=1.00), or valve migration (0% vs 1.4%; P=1.00) in BAV patients compared with non-BAV patients. Post-procedural mean gradient (10.0±3.4 vs 9.7±4.1 mm Hg; P=0.58), aortic regurgitation ≥2 of 4 (19.0% vs 14.9%; P=0.54), 30-day mortality (4.8% vs 8.2%; P=1.00), and 30-day combined safety end point (14.3% vs 13.5%; P=1.00) were also similar in both groups.
CONCLUSIONS: In selected BAV patients, transcatheter aortic valve implantation may be associated with low complication rate, efficacy, and acceptable outcomes similar to those in non-BAV patients.
Предметные рубрики MeSH
AgedAged, 80 and overAortic ValveAortic Valve StenosisBicuspid Aortic Valve DiseaseCardiac CatheterizationEchocardiography, Doppler, ColorEchocardiography, TransesophagealFemaleHeart Valve DiseasesHeart Valve ProsthesisHeart Valve Prosthesis ImplantationHumansMaleMultidetector Computed TomographyPatient SelectionPredictive Value of TestsProspective StudiesProsthesis DesignRisk FactorsSeverity of Illness IndexTime FactorsTreatment Outcome