Francesco Tartaglia, Mauro Gitto, Won-Keun Kim, Pier Pasquale Leone, Tommaso Fabris, Chiara De Biase, Giuliano Costa, Nicholas Montarello, Andrea Scotti, Michele Bellamoli, Mesfer Alfadhel, Ofir Koren, Simone Fezzi, Barbara Bellini, Mauro Massussi, Giulia Costa, Chiara Fraccaro, Alessandro Mazzapicchi, Enrico Giacomin, Francesco Burzotta, Andrea Zito, Riccardo Gorla, Marco Angelillis, Karsten Hug, Carlo Briguori, Luca Bettari, Antonio Messina, Michele Galasso, Damiano Regazzoli, Greta Cattaneo, Mauro Boiago, Gianmaria Calamita, Giulia Laterra, Matthias Renker, Mario Garcia Gomez, Alfonso Ielasi, Uri Landes, Tobias Rheude, Francesco Bedogni, Ignacio Amat Santos, Francesco Saia, Lin Bai, Mao Chen, Marianna Adamo, Marco De Carlo, Matteo Montorfano, Raj R Makkar, Darren Mylotte, Daniel J Blackman, Marco Barbanti, Didier Tchetche, Giuseppe Tarantini, Azeem Latib, Diego Maffeo, Ole De Backer, Andrea Buono, Antonio Mangieri
{"title":"经导管主动脉瓣置入术治疗raphe型二尖瓣狭窄后的高残留梯度：来自AD-HOC登记的见解。","authors":"Francesco Tartaglia, Mauro Gitto, Won-Keun Kim, Pier Pasquale Leone, Tommaso Fabris, Chiara De Biase, Giuliano Costa, Nicholas Montarello, Andrea Scotti, Michele Bellamoli, Mesfer Alfadhel, Ofir Koren, Simone Fezzi, Barbara Bellini, Mauro Massussi, Giulia Costa, Chiara Fraccaro, Alessandro Mazzapicchi, Enrico Giacomin, Francesco Burzotta, Andrea Zito, Riccardo Gorla, Marco Angelillis, Karsten Hug, Carlo Briguori, Luca Bettari, Antonio Messina, Michele Galasso, Damiano Regazzoli, Greta Cattaneo, Mauro Boiago, Gianmaria Calamita, Giulia Laterra, Matthias Renker, Mario Garcia Gomez, Alfonso Ielasi, Uri Landes, Tobias Rheude, Francesco Bedogni, Ignacio Amat Santos, Francesco Saia, Lin Bai, Mao Chen, Marianna Adamo, Marco De Carlo, Matteo Montorfano, Raj R Makkar, Darren Mylotte, Daniel J Blackman, Marco Barbanti, Didier Tchetche, Giuseppe Tarantini, Azeem Latib, Diego Maffeo, Ole De Backer, Andrea Buono, Antonio Mangieri","doi":"10.1007/s00392-025-02726-0","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Bicuspid aortic valve (BAV) stenosis poses several challenges when transcatheter aortic valve implantation (TAVI) is performed, including the risk of high residual gradients (HRG).</p><p><strong>Objective: </strong>To identify incidence, predictors and outcomes of HRG after TAVI in Sievers type 1 BAV stenosis.</p><p><strong>Methods: </strong>Consecutive patients with Sievers type 1 BAV stenosis undergoing TAVI at 24 international centers from 2016 to 2023 were enrolled. HRG were defined as a mean transvalvular gradient ≥ 20 mmHg at 30 days, according to Valve Academic Research Consortium-3 (VARC-3) criteria. The primary endpoint was major adverse cardiovascular events (MACE), defined as a composite of all-cause death, neurologic events or hospitalization for heart failure, assessed at 3 years after TAVI. Secondary endpoints included the single components of the primary outcome. Endpoints were assessed according to the presence of HRG, before and after covariate adjustment for clinically relevant confounders.</p><p><strong>Results: </strong>A total of 972 patients were enrolled. HRG post-TAVI were found in 35 patients (3.6%). Patients with HRG had a higher preprocedural aortic valve gradient (57.0 [interquartile range: 49.0-69.0] mmHg vs 48.0 [40.0-58.0] mmHg, p < 0.001) and received smaller transcatheter heart valve (THV) (26.0 [23.0-29.0] mm vs 29.0 [26.0-29.0] mm, p < 0.001) when compared to patients with normal residual gradients (NRG). The only independent predictor of HRG was a bioprosthesis size ≤ 23 mm. At 3 years, MACE occurred in 35.0% of HRG patients and 22.3% of NRG patients (adjusted hazard ratio [HR]: 2.41, 95% confidence interval [CI]: 1.15-5.04; p = 0.019). HRG patients had a higher risk of neurologic events as compared to NRG patients (13.3% versus 4.5%, adjusted HR: 4.50, 95% CI: 1.52-13.30, p = 0.007).</p><p><strong>Conclusions: </strong>After TAVI in Sievers type 1 BAV stenosis, HRG occurred in around 4% of cases and were associated with an increased risk of MACE and neurologic events.</p>","PeriodicalId":10474,"journal":{"name":"Clinical Research in Cardiology","volume":" ","pages":""},"PeriodicalIF":3.7000,"publicationDate":"2025-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"High residual gradients after transcatheter aortic valve implantation in raphe-type bicuspid aortic valve stenosis: insights from the AD-HOC registry.\",\"authors\":\"Francesco Tartaglia, Mauro Gitto, Won-Keun Kim, Pier Pasquale Leone, Tommaso Fabris, Chiara De Biase, Giuliano Costa, Nicholas Montarello, Andrea Scotti, Michele Bellamoli, Mesfer Alfadhel, Ofir Koren, Simone Fezzi, Barbara Bellini, Mauro Massussi, Giulia Costa, Chiara Fraccaro, Alessandro Mazzapicchi, Enrico Giacomin, Francesco Burzotta, Andrea Zito, Riccardo Gorla, Marco Angelillis, Karsten Hug, Carlo Briguori, Luca Bettari, Antonio Messina, Michele Galasso, Damiano Regazzoli, Greta Cattaneo, Mauro Boiago, Gianmaria Calamita, Giulia Laterra, Matthias Renker, Mario Garcia Gomez, Alfonso Ielasi, Uri Landes, Tobias Rheude, Francesco Bedogni, Ignacio Amat Santos, Francesco Saia, Lin Bai, Mao Chen, Marianna Adamo, Marco De Carlo, Matteo Montorfano, Raj R Makkar, Darren Mylotte, Daniel J Blackman, Marco Barbanti, Didier Tchetche, Giuseppe Tarantini, Azeem Latib, Diego Maffeo, Ole De Backer, Andrea Buono, Antonio Mangieri\",\"doi\":\"10.1007/s00392-025-02726-0\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Bicuspid aortic valve (BAV) stenosis poses several challenges when transcatheter aortic valve implantation (TAVI) is performed, including the risk of high residual gradients (HRG).</p><p><strong>Objective: </strong>To identify incidence, predictors and outcomes of HRG after TAVI in Sievers type 1 BAV stenosis.</p><p><strong>Methods: </strong>Consecutive patients with Sievers type 1 BAV stenosis undergoing TAVI at 24 international centers from 2016 to 2023 were enrolled. HRG were defined as a mean transvalvular gradient ≥ 20 mmHg at 30 days, according to Valve Academic Research Consortium-3 (VARC-3) criteria. The primary endpoint was major adverse cardiovascular events (MACE), defined as a composite of all-cause death, neurologic events or hospitalization for heart failure, assessed at 3 years after TAVI. Secondary endpoints included the single components of the primary outcome. Endpoints were assessed according to the presence of HRG, before and after covariate adjustment for clinically relevant confounders.</p><p><strong>Results: </strong>A total of 972 patients were enrolled. HRG post-TAVI were found in 35 patients (3.6%). Patients with HRG had a higher preprocedural aortic valve gradient (57.0 [interquartile range: 49.0-69.0] mmHg vs 48.0 [40.0-58.0] mmHg, p < 0.001) and received smaller transcatheter heart valve (THV) (26.0 [23.0-29.0] mm vs 29.0 [26.0-29.0] mm, p < 0.001) when compared to patients with normal residual gradients (NRG). The only independent predictor of HRG was a bioprosthesis size ≤ 23 mm. At 3 years, MACE occurred in 35.0% of HRG patients and 22.3% of NRG patients (adjusted hazard ratio [HR]: 2.41, 95% confidence interval [CI]: 1.15-5.04; p = 0.019). HRG patients had a higher risk of neurologic events as compared to NRG patients (13.3% versus 4.5%, adjusted HR: 4.50, 95% CI: 1.52-13.30, p = 0.007).</p><p><strong>Conclusions: </strong>After TAVI in Sievers type 1 BAV stenosis, HRG occurred in around 4% of cases and were associated with an increased risk of MACE and neurologic events.</p>\",\"PeriodicalId\":10474,\"journal\":{\"name\":\"Clinical Research in Cardiology\",\"volume\":\" \",\"pages\":\"\"},\"PeriodicalIF\":3.7000,\"publicationDate\":\"2025-08-06\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Clinical Research in Cardiology\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1007/s00392-025-02726-0\",\"RegionNum\":2,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"CARDIAC & CARDIOVASCULAR SYSTEMS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Clinical Research in Cardiology","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1007/s00392-025-02726-0","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"CARDIAC & CARDIOVASCULAR SYSTEMS","Score":null,"Total":0}
High residual gradients after transcatheter aortic valve implantation in raphe-type bicuspid aortic valve stenosis: insights from the AD-HOC registry.
Background: Bicuspid aortic valve (BAV) stenosis poses several challenges when transcatheter aortic valve implantation (TAVI) is performed, including the risk of high residual gradients (HRG).
Objective: To identify incidence, predictors and outcomes of HRG after TAVI in Sievers type 1 BAV stenosis.
Methods: Consecutive patients with Sievers type 1 BAV stenosis undergoing TAVI at 24 international centers from 2016 to 2023 were enrolled. HRG were defined as a mean transvalvular gradient ≥ 20 mmHg at 30 days, according to Valve Academic Research Consortium-3 (VARC-3) criteria. The primary endpoint was major adverse cardiovascular events (MACE), defined as a composite of all-cause death, neurologic events or hospitalization for heart failure, assessed at 3 years after TAVI. Secondary endpoints included the single components of the primary outcome. Endpoints were assessed according to the presence of HRG, before and after covariate adjustment for clinically relevant confounders.
Results: A total of 972 patients were enrolled. HRG post-TAVI were found in 35 patients (3.6%). Patients with HRG had a higher preprocedural aortic valve gradient (57.0 [interquartile range: 49.0-69.0] mmHg vs 48.0 [40.0-58.0] mmHg, p < 0.001) and received smaller transcatheter heart valve (THV) (26.0 [23.0-29.0] mm vs 29.0 [26.0-29.0] mm, p < 0.001) when compared to patients with normal residual gradients (NRG). The only independent predictor of HRG was a bioprosthesis size ≤ 23 mm. At 3 years, MACE occurred in 35.0% of HRG patients and 22.3% of NRG patients (adjusted hazard ratio [HR]: 2.41, 95% confidence interval [CI]: 1.15-5.04; p = 0.019). HRG patients had a higher risk of neurologic events as compared to NRG patients (13.3% versus 4.5%, adjusted HR: 4.50, 95% CI: 1.52-13.30, p = 0.007).
Conclusions: After TAVI in Sievers type 1 BAV stenosis, HRG occurred in around 4% of cases and were associated with an increased risk of MACE and neurologic events.
期刊介绍：
Clinical Research in Cardiology is an international journal for clinical cardiovascular research. It provides a forum for original and review articles as well as critical perspective articles. Articles are only accepted if they meet stringent scientific standards and have undergone peer review. The journal regularly receives articles from the field of clinical cardiology, angiology, as well as heart and vascular surgery.
As the official journal of the German Cardiac Society, it gives a current and competent survey on the diagnosis and therapy of heart and vascular diseases.
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