Debry Nicolas, Sudre Arnaud, Amr Gilles, Delhaye Cédric, Schurtz Guillaume, Montaigne David, Koussa Mohamad, Modine Thomas
Heart Team, Lille University Hospital, Lille, France.
Catheter Cardiovasc Interv. 2016 Mar;87(4):797-804. doi: 10.1002/ccd.26253. Epub 2015 Oct 1.
We compared the outcomes of transcatheter aortic valve implantation (TAVI) in three different aortic stenosis syndromes: paradoxical low-flow low-gradient aortic stenosis (PLFLG), high-gradient aortic stenosis (HGAS), and low ejection fraction low-gradient severe aortic stenosis (LEF-LG).
Outcomes for PLFLG patients after TAVI procedure are not well known.
Between 2010 and 2013, patients with severe (indexed aortic valve area iAVA≤0.6 cm(2)/m(2)) symptomatic aortic stenosis were consecutively referred to our institution for TAVI because of multiple comorbidities and excessive surgical risk. About 262 patients were split into three groups as following, PLFLG: mean gradient MG≤40 mm Hg, stroke volume index SVI≤35 mL/m(2), ejection fraction EF≥55%, valvuloarterial impedance Zva>4.5 mm Hg/mL/m(2), maximal aortic jet velocity MaxV<4 m/s;
LEF-LG: MG≤40 mm Hg, MaxV<4 m/s, EF≤50%, SVI≤35 mL/m(2); and HGAS: MaxV>4 m/s, MG>40 mm Hg, EF>55%. The primary endpoint of our study was to evaluate mid-term global and cardiovascular mortalities; secondary endpoints included recommended VARC-2 variables.
PLFLG (n = 31) mid-term survival was similar to HGAS (n = 172) (mean follow-up = 13.2 months [4.6-26]). Conversely LEF-LG patients (n = 59) displayed significant higher rates of all-cause (P = 0.01) and cardiovascular mortalities (P = 0.05). Postprocedural outcomes (VARC-2 criteria) were similar in the PLFLG and HGAS groups except regarding major bleeding (P = 0.02), while the LEF-LG group had more congestive heart failure and a higher BNP before discharge (both P < 0.001) than the other groups. 30-days deaths were significantly more frequent in LEF-LG and PLFLG in comparison to HGAS (P = 0.03).
As opposed to LEF-LG patients, mid-term prognosis after TAVI procedure in PLFLG patients is similar to HGAS patients despite higher perioperative mortality.
我们比较了经导管主动脉瓣植入术（TAVI）在三种不同主动脉瓣狭窄综合征中的结果：矛盾性低流量低梯度主动脉瓣狭窄（PLFLG）、高梯度主动脉瓣狭窄（HGAS）以及低射血分数低梯度严重主动脉瓣狭窄（LEF-LG）。
TAVI术后PLFLG患者的结果尚不清楚。
2010年至2013年期间，因多种合并症和手术风险过高，有严重（主动脉瓣指数面积iAVA≤0.6 cm²/m²）症状性主动脉瓣狭窄的患者被连续转诊至我院接受TAVI治疗。约262例患者分为以下三组，PLFLG组：平均梯度MG≤40 mmHg，每搏量指数SVI≤35 mL/m²，射血分数EF≥55%，瓣膜动脉阻抗Zva>4.5 mmHg/mL/m²，最大主动脉射流速度MaxV<4 m/s；
LEF-LG组：MG≤40 mmHg，MaxV<4 m/s，EF≤50%，SVI≤35 mL/m²；HGAS组：MaxV>4 m/s，MG>40 mmHg，EF>55%。我们研究的主要终点是评估中期全因死亡率和心血管死亡率；次要终点包括推荐的VARC-2变量。
PLFLG组（n = 31）的中期生存率与HGAS组（n = 172）相似（平均随访时间 = 13.2个月[4.6 - 26]）。相反，LEF-LG组患者（n = 59）的全因死亡率（P = 0.01）和心血管死亡率（P = 0.05）显著更高。PLFLG组和HGAS组术后结果（VARC-2标准）相似，但主要出血方面除外（P = 0.02），而LEF-LG组出院前充血性心力衰竭更多，脑钠肽水平更高（均P < 0.001），高于其他组。与HGAS组相比，LEF-LG组和PLFLG组30天死亡率显著更高（P = 0.03）。
与LEF-LG患者不同，尽管围手术期死亡率较高，但PLFLG患者TAVI术后的中期预后与HGAS患者相似。
