Comparison of the Hemodynamic Performance of Percutaneous and Surgical Bioprostheses for the Treatment of Severe Aortic Stenosis
Comparison of the Hemodynamic Performance of Percutaneous and Surgical Bioprostheses for the Treatment of Severe Aortic Stenosis
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DOI：
10.1016/j.jacc.2009.01.060
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发表时间：
2009-05-19
影响因子：
24
通讯作者：
Rodes-Cabau, Josep
中科院分区：
文献类型：
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作者：
Clavel, Marie-Annick;Webb, John G.;Rodes-Cabau, Josep
目的：本研究旨在比较经皮生物假体与手术植入（有支架和无支架）生物假体治疗严重主动脉狭窄的血流动力学性能。方法对50例经皮主动脉瓣植入术患者采用Cribier-Edwards或Edwards SAPIEN生物瓣膜（Edwards Lifesciences, Inc, Irvine, California）进行配对。1性别、主动脉环直径、左心室射血分数、体表面积和体重指数，其中两组50例患者接受了支架瓣膜置换术（Edwards Perimount Magna [SAVR- st组]）或无支架瓣膜置换术（Medtronic Freestyle, Medtronic, Minneapolis， Minnesota [SAVR- sl组]）。在干预前、出院时和随访6至12个月时，前瞻性地获得多普勒超声心动图数据。结果与SAVR-ST组（13 +/- 5 mm Hg）和SAVR-SL组（14 +/- 6 mm Hg）相比，PAVI组（10 +/- 4 mm Hg）的平均假体坡度较低（p < 0.001）。与SAVR-ST组（轻度：10%，中度：0%）和SAVR-SL组（轻度：12%，中度：0%）相比，PAVI组（轻度：42%，中度：8%）主动脉瓣反流（AR）发生频率更高（p < 0.0001）。随访时，PAVI组的平均梯度仍低于SAVR-ST组（p < 0.001），但与SAVR-SL组相似。与SAVR-ST组（28%）和SAVR-SL组（20%）相比，PAVI组（6%）严重假体-患者不匹配的发生率显著降低（p = 0.007）。然而，与其他两组相比，PAVI组的AR发生率仍然较高（p < 0.0001）。结论与外科生物假体相比，在经假体梯度和预防严重假体-患者不匹配方面，PAVI具有更好的血流动力学性能，但与更高的AR发生率相关。（J Am Coll Cardiol 2009; 53: 1883-91） (C) 2009由美国心脏病学会基金会发布
Objectives This study was undertaken to compare the hemodynamic performance of a percutaneous bioprosthesis to that of surgically implanted (stented and stentless) bioprostheses for the treatment of severe aortic stenosis.Methods Fifty patients who underwent percutaneous aortic valve implantation (PAVI) with the Cribier-Edwards or Edwards SAPIEN bioprosthetic valve (Edwards Lifesciences, Inc., Irvine, California) were matched 1: 1 for sex, aortic annulus diameter, left ventricular ejection fraction, body surface area, and body mass index, with 2 groups of 50 patients who underwent surgical aortic valve replacement (SAVR) with a stented valve (Edwards Perimount Magna [SAVR-ST group]), or a stentless valve (Medtronic Freestyle, Medtronic, Minneapolis, Minnesota [SAVR-SL group]). Doppler echocardiographic data were prospectively obtained before the intervention, at discharge, and at 6- to 12-month follow-up.Results Mean transprosthetic gradient at discharge was lower (p < 0.001) in the PAVI group (10 +/- 4 mm Hg) compared with the SAVR-ST (13 +/- 5 mm Hg) and SAVR-SL (14 +/- 6 mm Hg) groups. Aortic regurgitation (AR) occurred more frequently in the PAVI group (mild: 42%, moderate: 8%) compared with the SAVR-ST (mild: 10%, moderate: 0%) and SAVR-SL (mild: 12%, moderate: 0%) groups (p < 0.0001). At follow-up, the mean gradient in the PAVI group remained lower (p < 0.001) than that of the SAVR-ST group, but was similar to that of the SAVR-SL group. The incidence of severe prosthesis-patient mismatch was significantly lower (p = 0.007) in the PAVI group (6%) compared with the SAVR-ST (28%) and SAVR-SL (20%) groups. However, the incidence of AR remained higher (p < 0.0001) in the PAVI group compared with the 2 other groups.Conclusions PAVI provided superior hemodynamic performance compared with the surgical bioprostheses in terms of transprosthetic gradient and prevention of severe prosthesis-patient mismatch, but was associated with a higher incidence of AR. (J Am Coll Cardiol 2009; 53: 1883-91) (C) 2009 by the American College of Cardiology Foundation