Transcatheter Aortic Valve Replacement in Bicuspid Versus Tricuspid Aortic Valves From the STS/ACC TVT Registry
Transcatheter Aortic Valve Replacement in Bicuspid Versus Tricuspid Aortic Valves From the STS/ACC TVT Registry
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DOI：
10.1016/j.jcin.2020.03.022
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发表时间：
2020-08-10
影响因子：
11.3
通讯作者：
Reardon, Michael J.
中科院分区：
文献类型：
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作者：
Forrest, John K.;Kaple, Ryan K.;Reardon, Michael J.
目的 本研究旨在比较接受经导管主动脉瓣置换术 (TAVR) 的二尖瓣患者与三尖瓣患者的结果。 背景 TAVR 在三尖瓣主动脉瓣狭窄患者中显示出优异的安全性和有效性，但关于在二尖瓣患者中使用自扩张瓣膜的数据有限。 方法 使用胸外科医生协会/美国心脏病学会 TVT 登记处分析使用 Evolut R 或 Evolut PRO 瓣膜进行 TAVR 的患者。通过 1 年随访分析临床和超声心动图结果。 结果 2015 年 7 月至 2018 年 9 月期间，共有 932 名二叶式主动脉瓣狭窄患者接受了使用自膨式 Evolut R 或 Evolut PRO 瓣膜的择期 TAVR。将这些患者与同期接受 TAVR 的 26,154 名三尖瓣主动脉瓣狭窄患者进行比较。在基线时，二尖瓣患者更年轻，心脏合并症更少，并且胸外科医生协会预测死亡风险评分较低（5.3 +/- 4.2% vs. 6.9 +/- 4.8%；p < 0.001）。为了解释这些差异，进行了倾向匹配，结果产生了 929 个匹配对。在这些匹配组中，30 天（2.6% vs. 1.7%；p = 0.18）和 1 年（10.4% vs. 12.1%；p = 0.63）的全因死亡率，以及 30 天（3.4% vs. 2.7%；p = 0.41）和 1 年（3.9% vs. 4.4%；p = 0.41）的中风发生率= 0.93)，具有可比性。 结论 患者组之间的全因死亡率、卒中和瓣膜血流动力学在 30 天或 1 年时没有差异。对于手术风险较高的患者，二尖瓣主动脉瓣狭窄的 TAVR 表明安全性结果可接受且并发症发生率低。 (C) 2020 年，美国心脏病学会基金会。
OBJECTIVES This study sought to compare outcomes in patients with bicuspid versus tricuspid anatomy undergoing transcatheter aortic valve replacement (TAVR).BACKGROUND TAVR has shown excellent safety and efficacy in patients with tricuspid aortic valve stenosis, but limited data are available on the use of self-expanding valves in patients with bicuspid valves.METHODS The Society of Thoracic Surgeons/American College of Cardiology TVT Registry was used to analyze patients who underwent TAVR with the Evolut R or Evolut PRO valves. Clinical and echocardiographic outcomes were analyzed through 1-year follow-up.RESULTS Between July 2015 and September 2018 a total of 932 patients with bicuspid aortic valve stenosis underwent elective TAVR with the self-expanding Evolut R or Evolut PRO valve. These patients were compared with a group of 26,154 patients with tricuspid aortic stenosis who underwent TAVR during that same time period. At baseline, patients with bicuspid valves were younger, had fewer cardiac comorbidities, and had lower Society of Thoracic Surgeons Predicted Risk of Mortality scores (5.3 +/- 4.2% vs. 6.9 +/- 4.8%; p < 0.001). To account for these differences, propensity matching was performed, which resulted in 929 matched pairs. Within these match groups, the rates of all-cause mortality at 30 days (2.6% vs. 1.7%; p = 0.18) and 1 year (10.4% vs. 12.1%; p = 0.63), as well the rate of stroke at 30 days (3.4% vs. 2.7%; p = 0.41) and 1 year (3.9% vs. 4.4%; p = 0.93), were comparable.CONCLUSIONS All-cause mortality, stroke, and valve hemodynamics did not differ at 30 days or 1 year between patient groups. In patients at increased surgical risk, TAVR for bicuspid aortic valve stenosis indicates acceptable safety outcomes with low complications rates. (C) 2020 by the American College of Cardiology Foundation.