Forsberg Lena M, Tamás Éva, Vánky Farkas, Engvall Jan, Nylander Eva
Division of Clinical Physiology, Department of Medical and Health Sciences, Faculty of Health Sciences, Linköping University, Linköping, Sweden; Center for Medical Image Science and Visualization, Linköping University, Linköping, Sweden.
Catheter Cardiovasc Interv. 2013 Nov 15;82(6):1004-14. doi: 10.1002/ccd.24812. Epub 2013 Jun 27.
To evaluate longitudinal left and right ventricular function (LVF and RVF) after transcatheter aortic valve implantation (TAVI) as compared to surgical aortic valve replacement (SAVR) and LVF and RVF after TAVI by the transfemoral (TF) or transapical (TA) approach.
Knowledge about differences in recovery of LVF and RVF after TAVI and SAVR is scarce.
Sixty patients (age 81 ± 7 years, logistic EuroSCORE 16 ± 10%), undergoing TAVI (TF: n = 35 and TA: n = 25), were examined by echocardiography including atrioventricular plane displacement (AVPD) and peak systolic velocities (PSV) by tissue Doppler at basal RV free wall, LV lateral wall and septum preprocedurally, 7 weeks and 6 months postprocedurally. Twenty-seven SAVR patients were matched to 27 TAVI patients by age, gender and LVF.
Early postintervention, TAVI patients had improved longitudinal LVF. However, when analyzed separately, only TF, but not TA patients, had improved LV lateral and septal AVPD and PSV (all P ≤ 0.01). All TAVI patients, as well as the TF and TA group had unchanged longitudinal LVF between the early and late follow-ups (all P > 0.05). The SAVR group had higher septal LVF than the matched TAVI group preprocedurally, while postoperatively this difference was diminished. Longitudinal RVF was better in the TF group than in the TA group pre- and postprocedurally. Although the SAVR group had superior longitudinal RVF preoperatively, this was inferior to TAVI postoperatively.
Postprocedural longitudinal LVF and RVF in patients undergoing TF-TAVI, TA-TAVI, or SAVR differ considerably. Preservation of longitudinal RVF after TAVI might influence the selection of aortic valve intervention in the future.
评估经导管主动脉瓣植入术（TAVI）后左、右心室功能（LVF和RVF）的纵向变化，并与外科主动脉瓣置换术（SAVR）进行比较，同时评估经股动脉（TF）或经心尖（TA）途径TAVI后的LVF和RVF。
关于TAVI和SAVR后LVF和RVF恢复差异的知识较少。
60例患者（年龄81±7岁，逻辑EuroSCORE为16±10%）接受TAVI（TF：n = 35，TA：n = 25），术前、术后7周和6个月通过超声心动图检查，包括房室平面位移（AVPD）和组织多普勒测量的右心室游离壁基底、左心室侧壁和室间隔的收缩期峰值速度（PSV）。27例SAVR患者按年龄、性别和LVF与27例TAVI患者匹配。
干预后早期，TAVI患者的纵向LVF有所改善。然而，单独分析时，只有TF组患者的左心室侧壁和室间隔AVPD及PSV得到改善（均P≤0.01），TA组未改善。所有TAVI患者以及TF组和TA组在早期和晚期随访之间纵向LVF无变化（均P>0.05）。术前SAVR组的室间隔LVF高于匹配的TAVI组，而术后这种差异减小。TF组的纵向RVF在术前和术后均优于TA组。虽然SAVR组术前纵向RVF较好，但术后低于TAVI组。
接受TF-TAVI、TA-TAVI或SAVR的患者术后纵向LVF和RVF有显著差异。TAVI后纵向RVF的保留可能会影响未来主动脉瓣干预的选择。
