Wenjing Sheng, Jiaqi Fan, Jun Chen, Chongzhou Zheng, Dao Zhou, Hanyi Dai, Qiong Liu, Junhui Xue, Xian-Bao Liu
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The primary clinical outcome was major adverse cardiac and cerebrovascular events (MACCE), a composite of all-cause mortality, stroke and rehospitalisation for heart failure.Cox regression was used to adjust for confounders.</p><p><strong>Results: </strong>Compared with TAV patients, BAV recipients experienced higher technical failure rates (11.4% vs 6.0%, p=0.045) but lower permanent pacemaker implantation (4.7% vs 12%, p=0.008) at discharge. The 1-year MACCE rate was similar between groups (14.5% vs 9.8%, log-rank p=0.719), and Cox regression analyses adjusting for confounders revealed no significant difference (HR 1.408 (95% CI 0.622 to 3.191), p=0.412). Both groups demonstrated significant improvements in valve haemodynamics, with comparable rates of BVD (11.4% vs 9.2%, p=0.502) and structural valve dysfunction. Multivariate analysis demonstrated equivalent long-term survivals (HR 0.950 (95% CI 0.526 to 1.714), p=0.864) between groups.</p><p><strong>Conclusion: </strong>TAVR provides comparable clinical and haemodynamic outcomes for bicuspid and tricuspid AS with a small aortic annulus, despite greater procedural complexity in BAV cases. 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引用次数: 0
摘要
目的：比较经导管主动脉瓣置换术（TAVR）治疗严重二尖瓣和三尖瓣主动脉狭窄（AS）和小环空患者的临床结果和血流动力学表现。设计：基于前瞻性观察队列的回顾性分析。环境：2016年至2023年接受TAVR的患者的单中心登记。参与者：共有427例患者（193例双尖瓣（BAV）和234例三尖瓣（TAV）主动脉瓣），有症状的严重AS和小环空（中位面积381.5 mm2 (IQR 340.8 -406.4)），均接受术前多探头CT和标准化随访超声心动图检查。主要观察指标：比较两组患者的基线特征、技术成功、手术并发症、血流动力学表现和生物假体瓣膜功能障碍（BVD）。主要临床结局是主要心脑血管不良事件（MACCE），包括全因死亡率、中风和心力衰竭再住院。Cox回归用于校正混杂因素。结果：与TAV患者相比，BAV患者在出院时技术失败率更高（11.4% vs 6.0%, p=0.045），但永久起搏器植入率较低（4.7% vs 12%, p=0.008）。1年MACCE率组间相似（14.5% vs 9.8%, log-rank p=0.719），校正混杂因素的Cox回归分析显示无显著差异（HR 1.408 (95% CI 0.622 ~ 3.191), p=0.412）。两组瓣膜血流动力学均有显著改善，BVD发生率（11.4% vs 9.2%, p=0.502）和结构性瓣膜功能障碍发生率相当。多变量分析显示，两组间的长期生存率相当（HR 0.950 (95% CI 0.526 ~ 1.714), p=0.864）。结论：TAVR为小主动脉环的二尖瓣和三尖瓣AS提供了相当的临床和血流动力学结果，尽管BAV病例的操作更复杂。这些发现支持谨慎扩大TAVR以选择BAV患者，并进行细致的手术计划。
Transcatheter bicuspid versus tricuspid aortic valve replacement in patients with a small aortic annulus: an observational study.
Objective: To compare the clinical outcomes and haemodynamic performance following transcatheter aortic valve replacement (TAVR) in patients with severe bicuspid versus tricuspid aortic stenosis (AS) and small annuli.
Design: Retrospective analysis based on a prospective observational cohort.
Setting: Single-centre registry of patients undergoing TAVR between 2016 and 2023.
Participants: A total of 427 patients (193 bicuspid (BAV) and 234 tricuspid (TAV) aortic valve) with symptomatic severe AS and small annuli (median area 381.5 mm2 (IQR 348.0-406.4)), all undergoing preprocedural multidetector CT and standardised follow-up echocardiography.
Main outcomes measure: Baseline characteristics, technical success, procedural complications, haemodynamic performance and bioprosthetic-valve dysfunction (BVD) were compared between groups. The primary clinical outcome was major adverse cardiac and cerebrovascular events (MACCE), a composite of all-cause mortality, stroke and rehospitalisation for heart failure.Cox regression was used to adjust for confounders.
Results: Compared with TAV patients, BAV recipients experienced higher technical failure rates (11.4% vs 6.0%, p=0.045) but lower permanent pacemaker implantation (4.7% vs 12%, p=0.008) at discharge. The 1-year MACCE rate was similar between groups (14.5% vs 9.8%, log-rank p=0.719), and Cox regression analyses adjusting for confounders revealed no significant difference (HR 1.408 (95% CI 0.622 to 3.191), p=0.412). Both groups demonstrated significant improvements in valve haemodynamics, with comparable rates of BVD (11.4% vs 9.2%, p=0.502) and structural valve dysfunction. Multivariate analysis demonstrated equivalent long-term survivals (HR 0.950 (95% CI 0.526 to 1.714), p=0.864) between groups.
Conclusion: TAVR provides comparable clinical and haemodynamic outcomes for bicuspid and tricuspid AS with a small aortic annulus, despite greater procedural complexity in BAV cases. These findings support cautious expansion of TAVR to select BAV patients when performed with meticulous procedural planning.
期刊介绍：
Open Heart is an online-only, open access cardiology journal that aims to be “open” in many ways: open access (free access for all readers), open peer review (unblinded peer review) and open data (data sharing is encouraged). The goal is to ensure maximum transparency and maximum impact on research progress and patient care. The journal is dedicated to publishing high quality, peer reviewed medical research in all disciplines and therapeutic areas of cardiovascular medicine. Research is published across all study phases and designs, from study protocols to phase I trials to meta-analyses, including small or specialist studies. Opinionated discussions on controversial topics are welcomed. Open Heart aims to operate a fast submission and review process with continuous publication online, to ensure timely, up-to-date research is available worldwide. The journal adheres to a rigorous and transparent peer review process, and all articles go through a statistical assessment to ensure robustness of the analyses. Open Heart is an official journal of the British Cardiovascular Society.
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