Cardiology Department, Segeberger Kliniken GmbH, Bad Segeberg, Germany.
Am Heart J. 2010 Nov;160(5):862-9. doi: 10.1016/j.ahj.2010.07.017.
The conventional surgical aortic bioprostheses used for treatment of aortic stenosis (AS) are inherently stenotic in nature. The more favorable mechanical profile of the Medtronic CoreValve bioprosthesis may translate into a better hemodynamic and neurohormonal response.
The early hemodynamic and neurohormonal responses of 56 patients who underwent successful transcatheter aortic valve implantation (TAVI) using the Medtronic CoreValve bioprosthesis for severe symptomatic AS were compared with those of 36 patients who underwent surgical aortic valve replacement (SAVR) using tissue valves in the same period.
At baseline, patients in the TAVI and SAVR group had comparable indexed aortic valve area (0.33 ± 0.1 vs 0.34 ± 0.1 cm² , respectively; P = .69) and mean transvalvular gradient (51.1 ± 16.5 vs 53.1 ± 14.3 mm Hg, respectively; P = .56). At 30-day follow-up, mean transvalvular gradient was lower in the TAVI group than in the SAVR group (10.3 ± 4 vs 13.1 ± 6.2 mm Hg, respectively; P = .015), and the indexed aortic valve area was larger in the TAVI group (1.0 ± 0.14 vs 0.93 ± 0.13 cm²/m²; P = .017). There was a trend toward a higher incidence of moderate patient-prosthesis mismatch in the surgical group compared with the TAVI group (30.5% vs 17.8%, respectively; P = .11). The overall incidence of prosthetic regurgitation (any degree) was higher in the TAVI group than in the SAVR group (85.7% vs 16.7%, respectively; P < .00001). The left ventricular mass index decreased after TAVI (175.1 ± 61.8 vs 165.6 ± 57.2 g/m²; P = .0003) and remained unchanged after SAVR (165.1 ± 50.6 vs 161 ± 64.8 g/m²; P = .81). Similarly, NT-ProBNP decreased after TAVI (3,479 ± 2,716 vs 2,533 ± 1,849 pg/mL; P = .033) and remained unchanged after SAVR (1,836 ± 2,779 vs 1,689 ± 1,533 pg/mL; P = .78). There was a modest correlation between natriuretic peptides and left ventricular mass index in the whole cohort (r = 0.4, P = .013).
In patients with severe AS, TAVI resulted in lower transvalvular gradients and higher valve areas than SAVR. Such hemodynamic performance after TAVI may have contributed to early initiation of a reverse cardiac remodeling process and a decrease in natriuretic peptides.
用于治疗主动脉瓣狭窄（AS）的传统外科生物瓣在本质上存在狭窄。美敦力 CoreValve 生物瓣具有更有利的机械特性，可能会带来更好的血液动力学和神经激素反应。
将 56 例成功接受经导管主动脉瓣植入术（TAVI）的严重症状性 AS 患者（使用美敦力 CoreValve 生物瓣）的早期血液动力学和神经激素反应与同期 36 例接受外科主动脉瓣置换术（SAVR）的患者（使用组织瓣）进行比较。
在基线时，TAVI 和 SAVR 组的患者具有可比的指数化主动脉瓣面积（分别为 0.33 ± 0.1cm² 和 0.34 ± 0.1cm²；P =.69）和平均跨瓣梯度（分别为 51.1 ± 16.5mmHg 和 53.1 ± 14.3mmHg；P =.56）。在 30 天随访时，TAVI 组的平均跨瓣梯度低于 SAVR 组（分别为 10.3 ± 4mmHg 和 13.1 ± 6.2mmHg；P =.015），并且 TAVI 组的指数化主动脉瓣面积更大（分别为 1.0 ± 0.14cm²/m² 和 0.93 ± 0.13cm²/m²；P =.017）。与 TAVI 组相比，外科组患者-假体中度不匹配的发生率有升高趋势（分别为 30.5%和 17.8%；P =.11）。TAVI 组的任何程度的假体反流总发生率高于 SAVR 组（分别为 85.7%和 16.7%；P <.00001）。TAVI 后左心室质量指数降低（分别为 175.1 ± 61.8g/m² 和 165.6 ± 57.2g/m²；P =.0003），而 SAVR 后无变化（分别为 165.1 ± 50.6g/m² 和 161 ± 64.8g/m²；P =.81）。同样，TAVI 后 NT-ProBNP 降低（分别为 3479 ± 2716pg/mL 和 2533 ± 1849pg/mL；P =.033），而 SAVR 后无变化（分别为 1836 ± 2779pg/mL 和 1689 ± 1533pg/mL；P =.78）。整个队列中，利钠肽与左心室质量指数之间存在中度相关性（r = 0.4，P =.013）。
在严重 AS 患者中，TAVI 导致跨瓣梯度低于 SAVR，瓣口面积高于 SAVR。TAVI 后的这种血液动力学表现可能有助于早期启动心脏逆重构过程并降低利钠肽水平。
