한빛사 논문
Sung-Han Yoon MDa,*, Sabine Bleiziffer MDb, Ole De Backer MDc, Victoria Delgado MDd, Takahide Arai MDe, Johannes Ziegelmueller MDb, Marco Barbanti MDf, Rahul Sharma MDa, Gidon Y. Perlman MDg, Omar K. Khalique MDh, Erik W. Holy MDi, Smriti Saraf MDj, Florian Deuschl MDk, Buntaro Fujita MDl, Philipp Ruile MDm, Franz-Josef Neumann MDn, Gregor Pache MDn, Masao Takahashi MDo, Hidehiro Kaneko MDp, Tobias Schmidt MDq, Yohei Ohno MDg, Niklas Schofer MDk, William K.F. Kong MDd,r, Edgar Tay MDr, Daisuke Sugiyama MDs, Hiroyuki Kawamori MDa, Yoshio Maeno MDa, Yigal Abramowitz MDa, Tarun Chakravarty MDa, Mamoo Nakamura MDa, Shingo Kuwata MDt, Gerald Yong MDu, Hsien-Li Kao MDv, Michael Lee MDw, Hyo-Soo Kim MDx, Thomas Modine MDy, S. Chiu Wong MDz, Francesco Bedgoni MDaa, Luca Testa MDaa, Emmanuel Teiger MDo, Christian Butter MDp, Stephan M. Ensminger MDl, Ulrich Schaefer MDk, Danny Dvir MDg, Philipp Blanke MDg, Jonathon Leipsic MDg, Fabian Nietlispach MDt, Mohamed Abdel-Wahab MDi, Bernard Chevalier MDe, Corrado Tamburino MDf, David Hildick-Smith MDj, Brian K. Whisenant MDbb, Seung-Jung Park MDcc, Antonio Colombo MDdd, Azeem Latib MDdd, Susheel K. Kodali MDh, Jeroen J. Bax MDd, Lars Søndergaard MDc, John G. Webb MDe, Thierry Lefèvre MDe, Martin B. Leon MDh, Raj Makkar MDa
aDepartment of Interventional Cardiology, Cedars-Sinai Heart Institute, Los Angeles, California
bClinic for Cardiovascular Surgery, German Heart Center Munich, Germany
cThe Heart Centre, Rigshospitalet University Hospital, Copenhagen, Denmark
dDepartment of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
eGénérale de Santé, Institut Cardiovasculaire Paris Sud, Hopital Privé Jacques Cartier, Massy, France
fDivision of Cardiology, Ferrarotto Hospital, University of Catania, Catania, Italy
gDepartment of Cardiology, St Paul’s Hospital, University of British Columbia, Vancouver, British Columbia, Canada
hColumbia University Medical Center/New York Presbyterian Hospital, New York, New York
iHeart Center, Segeberger Kliniken GmbH, Academic Teaching Hospital of the Universities of Kiel, Hamburg, and Lübeck, Bad Segeberg, Germany
jSussex Cardiac Centre, Brighton and Sussex University Hospitals NHS Trust, Brighton, United Kingdom
kDepartment of General and Interventional Cardiology, University Heart Center, Hamburg, Germany
lDepartment of Thoracic and Cardiovascular Surgery, Heart and Diabetes Center NRW, Ruhr-University Bochum, Bad Oeynhausen, Germany
mDepartment of Cardiology & Angiology II, University Heart Center Freiburg-Bad Krozingen, Bad Krozingen, Germany
nDepartment of Radiology, Section of Cardiovascular Radiology, University of Freiburg, Bad Krozingen, Germany
oDepartment of Cardiology, Henri Mondor University Hospital, Créteil, France
pHeart Center Brandenburg in Bernau, Bernau, Germany
qDepartment of Cardiology, Asklepios Klink St. Georg, Hamburg, Germany
rDepartment of Cardiology, National University Heart Centre, Singapore
sDepartment of Preventive Medicine and Public Health, Keio University, Tokyo, Japan
tUniversity Heart Center, University Hospital Zurich, Zurich, Switzerland
uDivision of Cardiology, Royal Perth Hospital, Perth, Western Australia, Australia
vDepartment of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
wDivision of Cardiology, Queen Elizabeth Hospital, Kowloon, Hong Kong
xDepartment of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Korea
yDepartment of Cardiovascular Surgery, Hospital Cardiologique, Lille, France
zGreenberg Division of Cardiology, New York-Presbyterian Hospital, Weil Cornell Medicine, New York, New York
aaDepartment of Cardiology, IRCCS Pol San Donato, San Donato Milanese, Milan, Italy
bbDivision of Cardiovascular Diseases, Intermountain Heart Institute, Salt Lake City, Utah
ccDivision of Cardiology, University of Ulsan, Asan Medical Center, Seoul, Korea
ddInterventional Cardiology Unit, EMO-GVM Centro Cuore Columbus & San Raffaele Scientific Institute, Milan, Italy San Raffaele Hospital, Milan, Italy
*Corresponding author
Abstract
Background
Transcatheter aortic valve replacement (TAVR) is being increasingly performed in patients with bicuspid aortic valve stenosis (AS).
Objectives
This study sought to compare the procedural and clinical outcomes in patients with bicuspid versus tricuspid AS from the Bicuspid AS TAVR multicenter registry.
Methods
Outcomes of 561 patients with bicuspid AS and 4,546 patients with tricuspid AS were compared after propensity score matching, assembling 546 pairs of patients with similar baseline characteristics. Procedural and clinical outcomes were recorded according to Valve Academic Research Consortium-2 criteria.
Results
Compared with patients with tricuspid AS, patients with bicuspid AS had more frequent conversion to surgery (2.0% vs. 0.2%; p = 0.006) and a significantly lower device success rate (85.3% vs. 91.4%; p = 0.002). Early-generation devices were implanted in 320 patients with bicuspid and 321 patients with tricuspid AS, whereas new-generation devices were implanted in 226 and 225 patients with bicuspid and tricuspid AS, respectively. Within the group receiving early-generation devices, bicuspid AS had more frequent aortic root injury (4.5% vs. 0.0%; p = 0.015) when receiving the balloon-expanding device, and moderate-to-severe paravalvular leak (19.4% vs. 10.5%; p = 0.02) when receiving the self-expanding device. Among patients with new-generation devices, however, procedural results were comparable across different prostheses. The cumulative all-cause mortality rates at 2 years were comparable between bicuspid and tricuspid AS (17.2% vs. 19.4%; p = 0.28).
Conclusions
Compared with tricuspid AS, TAVR in bicuspid AS was associated with a similar prognosis, but lower device success rate. Procedural differences were observed in patients treated with the early-generation devices, whereas no differences were observed with the new-generation devices.
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