NYP Columbia Heart Valve Center, Columbia University Medical Center, New York, New York 10032, USA.
J Am Coll Cardiol. 2013 Jun 25;61(25):2514-21. doi: 10.1016/j.jacc.2013.02.087. Epub 2013 Apr 23.
This study sought to compare echocardiographic findings in patients with critical aortic stenosis following surgical aortic valve replacement (SAVR) or transcatheter aortic valve replacement (TAVR).
The PARTNER (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 after the procedure and analyzed in a core laboratory. For the analysis of post-implantation variables, the first interpretable study (≤6 months) 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 with SAVR, TAVR resulted in larger indexed EOA (p = 0.038), less prosthesis-patient mismatch (p = 0.019), and more total and paravalvular aortic regurgitation (p < 0.0001). Baseline echocardiographic univariate predictors of death were lower peak transaortic gradient in TAVR patients, and low left ventricular diastolic volume, low stroke volume, and greater severity of mitral regurgitation in SAVR patients. Post-implantation echocardiographic univariate predictors of death were: larger left ventricular diastolic volume, left ventricular systolic volume and EOA, decreased ejection fraction, and greater aortic regurgitation in TAVR patients; and smaller left ventricular systolic and diastolic volumes, 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 with SAVR, TAVR patients had higher indexed EOA, lower prosthesis-patient mismatch, and more aortic regurgitation. Univariate predictors of death for the TAVR and SAVR groups differed and might allow future refinement in patient selection. (THE PARTNER TRIAL: Placement of AoRTic TraNscathetER Valve Trial; NCT00530894).
本研究旨在比较经外科主动脉瓣置换术（SAVR）或经导管主动脉瓣置换术（TAVR）治疗的重症主动脉瓣狭窄患者的超声心动图表现。
PARTNER（经导管主动脉瓣置换术）试验以 1:1 的比例将患者随机分为 SAVR 或 TAVR 组。
在手术后基线、出院时、30 天、6 个月、1 年和 2 年时进行超声心动图检查，并在核心实验室进行分析。对于植入后变量的分析，使用第一次可解释的研究（≤6 个月）。
两组患者主动脉瓣跨瓣压差均降低，有效瓣口面积（EOA）均增加（p<0.0001），且 2 年内均保持稳定。与 SAVR 相比，TAVR 导致更大的指数化 EOA（p=0.038）、更小的瓣周漏（p=0.019）和更多的总瓣周漏和瓣周反流（p<0.0001）。TAVR 患者死亡的超声心动图单因素预测因素为峰值跨瓣压差较低，SAVR 患者为左心室舒张末期容积、心搏量和二尖瓣反流程度较低。TAVR 患者死亡的植入后超声心动图单因素预测因素为左心室舒张末期容积、左心室收缩末期容积和 EOA 较大、射血分数降低、主动脉瓣反流增加；SAVR 患者的预测因素为左心室收缩末期和舒张末期容积较小、心搏量较低、EOA 较小、瓣周漏和瓣周反流。
随机接受 SAVR 或 TAVR 治疗的患者经历了持续、显著的跨瓣压差降低和 EOA 增加。与 SAVR 相比，TAVR 患者的指数化 EOA 较高、瓣周漏较小、主动脉瓣反流更多。TAVR 和 SAVR 组患者死亡的单因素预测因素不同，这可能有助于未来对患者进行更精确的选择。
