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Progression of ascending aortopathy may not occur after transcatheter aortic valve replacement in severe bicuspid aortic stenosis

Korean Journal of Internal Medicine 2021년 36권 2호 p.332 ~ 341
정지현, 김형관, 박준빈, 이승표, 구본권, 김용진, 김효수, 손대원,
소속 상세정보
정지현 ( Jung Ji-Hyun ) - Seoul National University Hospital Department of Internal Medicine
김형관 ( Kim Hyung-Kwan ) - Seoul National University Hospital Department of Internal Medicine
박준빈 ( Park Jun-Bean ) - Seoul National University Hospital Department of Internal Medicine
이승표 ( Lee Seung-Pyo ) - Seoul National University Hospital Department of Internal Medicine
구본권 ( Koo Bon-Kwon ) - Seoul National University Hospital Department of Internal Medicine
김용진 ( Kim Yong-Jin ) - Seoul National University Hospital Department of Internal Medicine
김효수 ( Kim Hyo-Soo ) - Seoul National University Hospital Department of Internal Medicine
손대원 ( Sohn Dae-Won ) - Seoul National University Hospital Department of Internal Medicine

Abstract


Background/Aims: We evaluated changes in the ascending aorta dimension post-transcatheter aortic valve replacement (TAVR) in bicuspid aortic valve (BiAV) and tricuspid aortic valve (TAV) patients.

Methods: Patients with severe aortic stenosis undergoing TAVR at Seoul National University Hospital were consecutively recruited. Patients with less than 12 months’ follow-up and/or with an ascending aorta size larger than 50 mm were excluded. The ascending aorta size was measured on a parasternal long axis view using transthoracic echocardiography.

Results: Among the 67 patients who were included (age: 76.5 ± 6.5 years; male: 52.2%; AV area: 0.67 ± 0.15 cm2), 19 (28.4%) had BiAV; 48 (71.6%) had TAV. The median (interquartile ranges) follow-up duration was 398 days (361 to 451). BiAV patients were younger (73.2 ± 7.2 vs. 77.8 ± 5.8, p = 0.008), and had lower incidences of chronic renal disease (5.3% vs. 35.4%, p = 0.014) and history of coronary intervention (15.8% vs. 50.0%, p = 0.013), than TAV patients. On pre-procedural echocardiography, the ascending aorta dimensions in BiAV patients were larger than those in TAV patients (40.5 ± 3.8 mm vs. 35.9 ± 4.2 mm, p < 0.005). The ascending aorta dimension changed minimally during follow-up; post-TAVR, the ascending aorta’s growth rate was ?0.11 ± 1.9 and 0.26 ± 1.8 mm/yr in patients with BiAV and TAV, respectively (p = 0.50). Progression of the ascending aorta’s dimension postTAVR was not clinically significant in BiAV patients.

Conclusions: The concern about the progression of aortopathy in BiAV patients post-TAVR may not be a clinical issue. This should be confirmed in studies with a larger population and with a longer follow-up duration.

키워드

Aortic valve stenosis; Transcatheter aortic valve replacement; Bicuspid; Aortic aneurysm

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