Kochman Janusz, Kołtowski Lukasz, Huczek Zenon, Scisło Piotr, Bakoń Leopold, Wilimski Radosław, Rymuza Bartosz, Opolski Grzegorz
1 Department of Cardiology, Medical University of Warsaw, Warsaw, Poland.
Department of Cardiac Surgery, Medical University of Warsaw, Warsaw, Poland.
Postepy Kardiol Interwencyjnej. 2014;10(4):250-7. doi: 10.5114/pwki.2014.46766. Epub 2014 Nov 17.
Transaortic valve implantation (TAVI) has a well-established position in the treatment of high-risk and inoperable patients with severe aortic stenosis (AS). The TAVI protocol requires a pre-dilatation for native valve preparation.
To assess the safety and feasibility of TAVI without pre-dilatation and to compare it with the procedure with pre-dilatation.
Out of 101 TAVI patients, in 10 the procedure was performed without balloon predilatation, and 8 patients were included in the analysis. The procedural, echocardiographic, and clinical outcomes were compared with a case control matched cohort (1: 2 ratio). A 12-month follow-up was done in all cases.
The procedure was successfully completed in all patients in the study group (SG), but there was one procedural failure in the control group (CG). All patients received a CoreValve (Medtronic) bioprosthesis. There was a significant immediate decrease in transvalvular gradients (TG) in both study arms after the procedure (SG: mean TG: from 46.0 ±14.0 mm Hg to 10.0 ±4.8 mm Hg, p < 0.001; CG: mean TG: from 55.9 ±12.0 mm Hg to 9.9 ±2.9 mm Hg, p < 0.001). A marked increase in the effective orifice areas was observed in both cohorts (SG: 1.63 ±0.13 cm(2) and CG: 1.67 ±0.25 cm(2), p = 0.75). The periprocedural complication rate was equally distributed in both arms. The 12-month all-cause mortality was 12.5% in both groups.
The direct TAVI approach seams to be safe and feasible. The clinical and echocardiographic results are not different from those achieved in patients treated with standard TAVI protocol with pre-dilatation.
经导管主动脉瓣植入术(TAVI)在治疗高危及无法手术的严重主动脉瓣狭窄(AS)患者中已确立了稳固地位。TAVI方案要求对自体瓣膜进行预扩张。
评估无预扩张TAVI的安全性和可行性,并将其与有预扩张的手术进行比较。
在101例TAVI患者中,10例手术未进行球囊预扩张,8例纳入分析。将手术、超声心动图及临床结果与病例对照匹配队列(1:2比例)进行比较。所有病例均进行了12个月的随访。
研究组(SG)所有患者手术均成功完成,但对照组(CG)有1例手术失败。所有患者均接受了美敦力公司的CoreValve生物假体。术后两组跨瓣压差(TG)均立即显著下降(SG:平均TG:从46.0±14.0 mmHg降至10.0±4.8 mmHg,p<0.001;CG:平均TG:从55.9±12.0 mmHg降至9.9±2.9 mmHg,p<0.001)。两组有效瓣口面积均显著增加(SG:1.63±0.13 cm²,CG:1.67±0.25 cm²,p = 0.75)。围手术期并发症发生率在两组中分布相同。两组12个月全因死亡率均为12.5%。
直接TAVI方法似乎是安全可行的。其临床和超声心动图结果与采用标准预扩张TAVI方案治疗的患者并无差异。