Transcatheter aortic valve replacement outcomes in bicuspid compared to trileaflet aortic valves

被引:18
作者
Nagaraja, Vinayak [1 ,2 ,3 ]
Suh, William [4 ]
Fischman, David L. [5 ]
Banning, Adrian [6 ]
Martinez, Sara C. [7 ]
Potts, Jessica [1 ,2 ]
Kwok, Chun Shing [1 ,8 ]
Ratib, Karim [1 ,2 ]
Nolan, Jim [1 ,2 ]
Bagur, Rodrigo [1 ,2 ]
Mamas, Mamas A. [1 ,2 ]
机构
[1] Keele Univ, Keele Cardiovasc Res Grp, Inst Primary Care & Hlth Sci, Ctr Prognosis Res, Stoke On Trent ST4 7QB, Staffs, England
[2] Royal Stoke Hosp, Acad Dept Cardiol, Stoke On Trent, Staffs, England
[3] Prince Wales Hosp & Community Hlth Serv, Dept Cardiol, Randwick, NSW, Australia
[4] Univ Calif Los Angeles, Med Ctr, David Geffen Sch Med, Div Cardiol, Los Angeles, CA 90095 USA
[5] Thomas Jefferson Univ Hosp, Dept Med Cardiol, Philadelphia, PA 19107 USA
[6] Oxford Univ Hosp NHS Trust Fdn, Oxford Heart Ctr, Oxford, England
[7] Providence St Peter Hosp, Div Cardiol, Olympia, WA USA
[8] Univ Hosp North Midlands, Dept Cardiol, Stoke On Trent, Staffs, England
关键词
Bicuspid aortic valves; Transcatheter aortic valve replacement; Mortality; Periprocedural complication; CLINICAL-OUTCOMES; HIGH-RISK; IMPLANTATION; STENOSIS; GENERATION; CLASSIFICATION; COMPLICATIONS; METAANALYSIS; FREQUENCY; SAPIEN;
D O I
10.1016/j.carrev.2018.09.013
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Aim: TAVR in patients with bicuspid aortic valves (BAV) is more challenging compared to individuals with trileaflet aortic valves (TAV). BAV have been excluded from the large randomized clinical trials assessing transcatheter aortic valve replacements (TAVR) and has been considered as a relative contraindication to TAVR. To report the outcomes of TAVR in BAV and compare them to TAV in the National Inpatient Sample (NIS). Methods and results: TAVR procedures were identified between 2011 and 2014 in the NIS dataset. Endpoints assessed included in-hospital mortality, periprocedural complications, length of stay and cost. Of 40,604 identified TAVR procedures, 407 (1%) were BAV and the 40,197 (99%) were TAV. Patients with BAV were younger and had a lower comorbidity burden. In hospital mortality (4.89% vs 4.17%, OR: 1.71,95%CI 0.57-5.12, P = 021), AMI (3.49% vs 3.58%, OR: 1.12, 95%CI: 036-3.54, P - 0.85), stroke and TIA (2.49% vs 3.55%, OR: 0.75, 95%Cl: 0.18-3.16, P = 0.70), vascular complications (2.39% vs 5.58%, OR:0.47, 95%CI: 0.11-1.93, P - 0.29), major bleeding (16.96% vs 23.50%, OR: 0.63, 95%CI: 0.34-1.17, P - 0.15) and rates of permanent pacemaker (PPM) (9.88% vs 10.88%, OR: 1.19, 95%CI: 0.57-251, P = 0.64) were similar in both cohorts. Conclusions: With multimodality imaging and further improvement in technology, our study demonstrates off-label TAVR should not be considered prohibitive and can be successfully performed for BAV with similar periprocedural outcomes compared to those with TAV. However, there is a need for robust large prospective studies. (C) 2018 Elsevier Inc. All rights reserved.
引用
收藏
页码:50 / 56
页数:7
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