Background

Transcatheter aortic valve replacement (TAVR) is safe and feasible in patients with bicuspid aortic valve (BAV), but whether annular size may influence TAVR results in BAV patients remains unclear. We aimed at evaluating the impact of aortic annular size on procedural and clinical outcomes of BAV patients undergoing TAVR, as well as potential interactions between annular dimension and trans-catheter heart valve (THV) type (balloon-expandable (BEV) vs. self-expanding (SEV).

Methods

BEAT is a multicenter registry of consecutive BAV stenosis undergoing TAVR. For this sub-study patients were classified according to annular dimension in small-annulus (area < 400 mm² or perimeter <72 mm), medium-annulus (area ≥ 400 and < 575 mm², perimeter ≥72 mm and< 85 mm), large-annulus (area ≥ 575 mm² or perimeter ≥85 mm). Primary endpoint was Valve Academic Research Consortium-2 (VARC-2) device success.

Results

45(15.5%) patients had small, 132(45.3%) medium, and 114(39.2%) large annuli. Compared with other groups, patients with large annuli were more frequently male, younger, with higher body mass index, larger aortic valve area, higher rate of moderate-severe calcification, lower mean trans-aortic valve gradient and lower left ventricular ejection fraction. In large-annuli SEVs were associated with a lower VARC-2 device success (75.9% vs. 90.6%, p = 0.049) driven by a higher rate of paravalvular valvular leak (PVL) compared to BEVs (20.7% vs. 1.2%, p < 0.001). However, no differences in clinical outcomes were observed according to annular size nor THV type.

Conclusions

TAVR in BAV patients is feasible irrespective of annular size. However in patients with large aortic annulus SEVs were associated with a significantly higher rate of PVLs compared to BEVs.

中文翻译：

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用于治疗严重二尖瓣主动脉瓣狭窄的瓣环尺寸和与经导管主动脉瓣的相互作用：来自 BEAT 登记处的见解

背景

经导管主动脉瓣置换术 (TAVR) 对二尖瓣主动脉瓣 (BAV) 患者是安全可行的，但瓣环大小是否会影响 BAV 患者的 TAVR 结果仍不清楚。我们旨在评估主动脉瓣环尺寸对接受 TAVR 的 BAV 患者的手术和临床结果的影响，以及主动脉瓣环尺寸与经导管心脏瓣膜 (THV) 类型（球囊扩张型 (BEV) 与自我扩张型）之间的潜在相互作用。扩展（SEV）。

方法

BEAT 是接受 TAVR 的连续 BAV 狭窄的多中心登记。对于该子研究，患者根据环尺寸分为小环（面积 < 400 mm ²或周长 <72 mm）、中环（面积 ≥ 400 和 < 575 mm ²、周长 ≥72 mm 和 < 85 mm )，大环（面积 ≥ 575 mm ²或周长 ≥85 mm）。主要终点是 Valve Academic Research Consortium-2 (VARC-2) 设备的成功。

结果

45 (15.5%) 名患者有小环、132 (45.3%) 中型和 114 (39.2%) 大环。与其他组相比，大瓣环患者男性较多、年龄较小、体重指数较高、主动脉瓣面积较大、中重度钙化率较高、平均跨主动脉瓣梯度较低、左心室射血分数较低。与 BEV（20.7% 对 1.2% ，p  < 0.001)。然而，根据环形大小和 THV 类型，没有观察到临床结果的差异。

结论

无论环形大小如何，BAV 患者的 TAVR 都是可行的。然而，与 BEV 相比，在大主动脉瓣环患者中，SEV 的 PVL 发生率显着升高。