Transcatheter aortic valve implantation for bicuspid aortic valve stenosis: Acute and intermediate-term outcomes in a high volume institution

Abstract

IzvlečekIzhodišče: Prikazujemo rezultate naše skupine bolnikov z bikuspidno aortno (BAV) stenozo, ki smo jim perkutano vstavili umetno aortno zaklopko. Metode:Retrospektivno smo analizirali perioperativne podatke in podatke s kontrolnih pregledov. Vsi bolniki so bili zdravljeni z metodo transkatetrske vstavitve aortne zaklopke (angl. transcatheter aortic valve implantation, TAVI) v centru z velikim številom posegov.Rezultati: 33 bolnikov z bikuspidno aortno zaklopko (55-87 let) smo zdravili z metodo transkatetrske zamenjave aortne zaklopke. Srednji logistični EuroSCORE (angl. European System for Cardiac Operative Risk Evaluation) je bil 23,2 ± 19,3. Večini pacientov smo vstavili zaklopko Edwards Sapien® s transapikalnim pristopom (87,9 %). 9 bolnikom (27,3 %) smo morali dodatno balonsko razširiti zaklopko zaradi zmerne do hude paravalvularne regurgitacije, 3 bolnikom (9 %) smo morali vstaviti drugo zaklopko zaradi vztrajajoče hude paravalvularne regurgitacije, 2 bolnika (6 %) pa smo morali nato še klasično operirati s pristopom preko mediane sternotomije. Po posegu je bila blaga aortna regurgitacija prisotna pri 12 bolnikih (36,4%), zmerna AR pri 3 %, regurgitacije večje kot stopnja 2, pa nismo zabeležili. Uspešnost delovanja aortne zaklopke po perkutani metodi smo glede na merilo VARC (angl. Valve Academic Research Consortium) ocenili na 82 %. Med bolniki z in bolniki brez paravalvularne regurgitacije po posegu ni bilo pomembnih razlik v anatomiji BAV, razporeditvi kalcija in velikosti ter tipu vgrajene umetne zaklopke. 30-dnevno preživetje je bilo 100 %, 2-letno pa 70 % (CI: 52.7-93.1), kar je podobno pri bolnikih s paravalvularno regurgitacijo po posegu ali brez nje.Zaključki: Transkatetrska zamenjava aortne zaklopke je izvedljiva pri bolnikih s stenozo bikuspidne aortne zaklopke. Tudi v izkušenih centrih je tehnično zahteven poseg povezan z večjim številom dodatnih balonskih dilatacij, vstavitvijo dodatne druge zaklopke ali potrebo po klasični kardiokirurški operaciji. Zanimivo bo videti, ali bodo rezultati podobni tudi pri novejši drugi generaciji perkutanih aortnih zaklopk. AbstractBackground: We report our experience with transcatheter aortic valve implantation (TAVI) in patients with bicuspid aortic valve (BAV) stenosis.Transcatheter aortic valve implantation for bicuspid aortic valve stenosis 9 iZVirni ZnAnSTVeni čLAneK ter aortic ntation d aortic sis Prispelo: 3. 9. 2016 Sprejeto: 26. 12. 2016 Methods: Perioperative and intermediate-term follow-up data were retrospectively analysed. All procedures were performed within the premises of an experienced high-volume TAVI centre.Results: Thirty-three consecutive BAV patients (age 55 to 87 years) underwent TAVI. Mean logistic European System for Cardiac Operative Risk Evaluation (EuroSCORE) was 23,2 ± 19,3. Transapical Edwards Sapien® valve was implanted in the majority of patients (87.9 %). Nine patients (27.3 %) required post-ballooning of the implanted valve for moderate to severe paravalvular leak, 3 patients (9 %) required a second valve implantation fo...

Procedural and clinical outcomes of transcatheter aortic valve replacement in bicuspid aortic valve patients: a systematic review and meta-analysis

“…The route of access was reported in 18 studies, and 91.8% of procedures were transfemoral. The most common devices used were the CoreValve (Medtronic, Minneapolis, Minnesota, USA) and Evolut R (Medtronic) (15,18,25-27, 29,30,32-41), used in 17 studies, and the SAPIEN 3 (Edwards Lifesciences, Irvine, California, USA) and SAPIEN XT valves (Edwards Lifesciences), used in 13 studies (15,26,30,(32)(33)(34)(35)(36)(37)(38)(39)(40)42). The Lotus EDGE (Boston Scientific, Marlborough, Massachusetts, USA) was used in six studies (15,25,26,28,33,35) and the VenusA-valve (Venus MedTech, Hangzhou, China) was used in four studies from Mainland China (18,24,31,33).…”

25th anniversary of the Department of Cardiac Surgery at the University Medical Center Maribor: advancing hearts, changing lives

“…Our current surgical portfolio includes surgery for ischemic heart diseases (with or without cardiopulmonary bypass, multiarterial grafting, minimally invasive myocardial revascularization [ 3 , 4 ] and surgical treatment of complications, such as ventricular septal defects, myocardial ruptures and left ventricular aneurysms), aortic valve replacement with mechanical or stented bioprostheses, aortic valve repair and valve-sparing aortic root replacement (both reimplantation and remodelling with external annuloplasty) [ 5 ], minimally invasive aortic [ 6 ] and mitral valve surgery [ 7 , 8 ], mitral valve repair and replacement [ 9 ], surgical treatment of any heart valve endocarditis, surgery for tricuspid or pulmonary valve disease, aortic surgery (aortic dissection, ascending and arch aneurysms including the frozen elephant trunk procedure [ 10 ], trauma to the great vessels), surgery for atrial fibrillation [ 11 ], pericardiectomy, surgery for cardiac neoplasms, temporary mechanical circulatory support (intra-aortic balloon pump, extracorporeal membrane oxygenation) [ 12 , 13 ] and carotid endarterectomy. In addition, we provide surgical assistance and standby for various interventional cardiological (percutaneous coronary interventions, transcatheter aortic valve implantations [ 14 , 15 ], interventional treatment for atrial and ventricular arrhythmias) or radiological (thoracic endovascular aortic repair) procedures. Surgical implantation of pacemakers and automatic defibrillators is also performed at our institution [ 16 ] as well as treatment of postoperative deep sternal wound infections [ 17 , 18 ].…”