Comparison of transcatheter and surgical aortic valve replacement in severe aortic stenosis: a longitudinal study of echocardiography parameters in cohort A of the PARTNER trial (placement of aortic transcatheter valves).
Comparison of transcatheter and surgical aortic valve replacement in severe aortic stenosis: a longitudinal study of echocardiography parameters in cohort A of the PARTNER trial (placement of aortic transcatheter valves).
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经导管和外科主动脉瓣置换术治疗严重主动脉瓣狭窄的比较：PARTNER 试验 A 组超声心动图参数的纵向研究（经导管主动脉瓣膜置入）。
DOI：
10.1016/j.jacc.2013.02.087
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发表时间：
2013-06-25
影响因子：
24
通讯作者：
Douglas, Pamela S.
中科院分区：
文献类型：
--
作者：
Hahn, Rebecca T.;Pibarot, Philippe;Stewart, William J.;Weissman, Neil J.;Gopalakrishnan, Deepika;Keane, Martin G.;Anwaruddin, Saif;Wang, Zuyue;Bilsker, Martin;Lindman, Brian R.;Herrmann, Howard C.;Kodali, Susheel K.;Makkar, Raj;Thourani, Vinod H.;Svensson, Lars G.;Akin, Jodi J.;Anderson, William N.;Leon, Martin B.;Douglas, Pamela S.
关键词：
比较外科手术（SAVR）或经导管主动脉瓣置换术（TAVR）后严重主动脉瓣狭窄患者的超声心动图结果。经导管主动脉瓣置入试验将患者1：1随机分配至SAVR或TAVR组，在基线、出院、术后30天、6个月、1年和2年时获得超声心动图，并在核心实验室进行分析。对于植入后变量的分析，使用了第一项可解释研究（≤ 6个月）。两组均显示主动脉瓣压差降低，有效瓣口面积（EOA）增加（p < 0.0001），在2年内保持稳定。与SAVR相比，TAVR导致：EOA指数更大（p = 0.038），假体-患者不匹配更少（p = 0.019），总主动脉瓣返流和瓣周主动脉瓣返流（AR）更多（p < 0.0001）。死亡的基线超声心动图单变量预测因子为：TAVR患者的跨主动脉瓣压差峰值较低; SAVR患者的左心室舒张期容积（LVDV）较低、每搏输出量较低和二尖瓣返流严重程度较高。植入后超声心动图死亡的单变量预测因子为：TAVR患者的LVDV、收缩期容积（LVSV）和EOA较大、射血分数降低和AR较大; SAVR患者的LVSV和LVDV较小、每搏输出量低、EOA较小和假体-患者不匹配。随机分配至SAVR或TAVR的患者经历了持续的、显著的跨主动脉压差降低和EOA增加。与SAVR相比，TAVR患者的EOA指数更高，假体-患者不匹配更低，AR更多。TAVR组和SAVR组的死亡单变量预测因素不同，可能允许将来在患者选择中进行细化。
To compare echocardiographic findings in patients with critical aortic stenosis following surgical (SAVR) or transcatheter aortic valve replacement (TAVR The Placement of Aortic Transcatheter Valves trial randomized patients 1:1 to SAVR or TAVR Echocardiograms were obtained at baseline, discharge, 30 days, 6 months, 1 year, and 2 years post procedure and analyzed in a core laboratory. For the analysis of post-implant variables, the first interpretable study (≤ 6 mos) was used. Both groups showed a decrease in aortic valve gradients and increase in effective orifice area (EOA) (p < 0.0001) which remained stable over 2 years. Compared to SAVR, TAVR resulted in: larger indexed EOA (p = 0.038), less prosthesis-patient mismatch (p = 0.019), and more total and paravalvular aortic regurgitation (AR) (p < 0.0001). Baseline echocardiographic univariate predictors of death were: lower peak transaortic gradient in TAVR patients; low left ventricular diastolic volume (LVDV), low stroke volume, and greater severity of mitral regurgitation in SAVR patients. Post-implantation echocardiographic univariate predictors of death were: larger LVDV, systolic volume (LVSV) and EOA, decreased ejection fraction, and greater AR in TAVR patients; smaller LVSV and LVDV, low stroke volume, smaller EOA and prosthesis-patient mismatch in SAVR patients. Patients randomized to either SAVR or TAVR experience enduring, significant reductions in transaortic gradients and increase in EOA. Compared to SAVR, TAVR patients had higher indexed EOA, lower prosthesis-patient mismatch and more AR. Univariate predictors of death for the TAVR group and SAVR groups differed and may allow future refinement in patient selection.
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