Article
作者: Angelillis, Marco ; Boiago, Mauro ; Navazio, Edoardo ; Costa, Giuliano ; Montarello, Nicholas ; Latib, Azeem ; Mangieri, Antonio ; Maffeo, Diego ; Nagasaka, Takashi ; Buono, Andrea ; Bellamoli, Michele ; Favero, Luca ; Barbanti, Marco ; Strazzieri, Orazio ; Brambilla, Nedy ; Landes, Uri ; Tarantini, Giuseppe ; Tchètchè, Didier ; Fabris, Tommaso ; Mazzapicchi, Alessandro ; Napodano, Massimo ; Bedogni, Francesco ; Blackman, Daniel J ; Kim, Won-Keun ; Villa, Emmanuel ; Fezzi, Simone ; Makkar, Raj R ; Sondergaard, Lars ; Scotti, Andrea ; Bellini, Barbara ; Costa, Giulia ; De Biase, Chiara ; Alfadhel, Mesfer ; Saia, Francesco ; Bettari, Luca ; Adamo, Marianna ; Chen, Mao ; Messina, Antonio ; Mylotte, Darren ; De Backer, Ole ; Paglianiti, Donato Antonio ; Zito, Andrea ; Giacomin, Enrico ; Gorla, Riccardo ; Massussi, Mauro ; Montorfano, Matteo ; Latini, Alessia ; Fraccaro, Chiara ; Busco, Marco ; Ielasi, Alfonso ; Orbach, Ady ; Petronio, Anna Sonia ; Koren, Ofir ; Bai, Lin ; Charitos, Efstratios
BACKGROUNDRaphe-type bicuspid aortic valve (BAV) is a potential hostile scenario in trans-catheter aortic valve replacement (TAVR) due to pronounced calcium burden, possibly associated with tapered valve configuration. Trans-Catheter heart valve (THV) sizing strategy (annular vs. supra-annular) is controversial in this valve subtype.OBJECTIVESTo describe the phenotypical characteristics of severe, tapered, raphe-type, BAV stenosis undergoing TAVR and to explore safety and efficacy of modern-generation THVs, analysing the impact of annular and supra-annular sizing strategies on short- and mid-terms outcomes.METHODSThis is a retrospective, multicenter registry enrolling consecutive stenotic Sievers type 1 BAV treated with TAVR. Study population was divided into tapered and non-tapered configuration according to MSCT analysis. Matched comparison between annular and supra-annular sizing groups was performed in tapered population.RESULTSFrom January 2016 to June 2023, 897 patients were enrolled. Of them, 696 patients displayed a tapered configuration. Of those, 510 received a THV according to annular sizing. After propensity score matching 186 matched pairs were selected. Technical success (96.2 % vs 94.1 %, OR 1.61 [0.61-4.24], p = 0.34), 30-day device success (83.6 % in both groups, OR 1.42 [0.78-2.57], p = 0.25) and 30-day early safety (71.8 % vs 70.5 %, OR 1.07 [0.68-1.68], p = 0.78) were similar between the annular and supra-annular sizing groups; a higher post-TAVR gradient was observed in supra-annular group, although it was only 2 mmHg mean. At mid-term follow-up, the rate of clinical efficacy was 84.7 %.CONCLUSIONSTAVR with modern-generation devices is safe and effective for tapered raphe-type BAV, showing comparable results for annular and supra-annular sizing strategies.