D'Onofrio Augusto, Besola Laura, Rizzoli Giulio, Bizzotto Eleonora, Manzan Erica, Tessari Chiara, Bianco Roberto, Tarantini Giuseppe, Badano Luigi P, Napodano Massimo, Fraccaro Chiara, Pittarello Demetrio, Gerosa Gino
Division of Cardiac Surgery, University of Padova, Padova, Italy.
Division of Cardiac Surgery, University of Padova, Padova, Italy.
Ann Thorac Surg. 2017 Feb;103(2):559-566. doi: 10.1016/j.athoracsur.2016.06.042. Epub 2016 Sep 7.
This single-center retrospective study assessed the variation of left ventricular ejection fraction (LVEF) after transapical transcatheter aortic valve implantation and its effect on survival. We also evaluated the effect of sheath diameter on LVEF.
We analyzed data of all consecutive patients who underwent transapical transcatheter aortic valve implantation with the Sapien (Edwards Lifesciences, Irvine, CA) device (and its evolutions) between 2009 and 2015. We analyzed the difference between preoperative LVEF and LVEF at discharge (ΔEF = LVEFpost-op - LVEFpre-op) and considered its interquartile range (±5%) as the cutoff. Patients were divided in three groups: (1) improved LVEF (ΔEF ≥ +5%); (2) unchanged LVEF (ΔEF -5% to +5%), and (3) worsened LVEF (ΔEF ≤ -5%). Survival was evaluated with Kaplan-Meier analysis, and logistic regression multivariable analysis was used to determine independent predictors of LVEF improvement.
Data of 122 patients were analyzed. Patients in the three groups were distributed as follows: (group 1) 27 patients (22.1%), (group 2) 69 (56.6%), and (group 3) 26 (21.3%). The mean ΔEF was 12.7% ± 4.7% in group 1 and -10.8% ± 3.9% in group 3. The ΔEF was more likely to improve in patients with preoperative LVEF of less than 0.35 (p = 0.014). There were no significant differences in survival (p = 0.41), rehospitalization (p = 0.472), and New York Heart Association Functional Classification (p = 0.307) among the groups. The use of the smallest available sheath (18F) was not associated with a significant change of ΔEF.
LVEF worsened in a small number of patients after transapical transcatheter aortic valve implantation, but this change was not associated with worse postoperative outcomes. Patients with a low LVEF showed better improvement. The progressive reduction of sheath diameter does not have a significant effect on LVEF changes.
本单中心回顾性研究评估了经心尖经导管主动脉瓣植入术后左心室射血分数（LVEF）的变化及其对生存率的影响。我们还评估了鞘管直径对LVEF的影响。
我们分析了2009年至2015年间所有连续接受使用Sapien（爱德华生命科学公司，加利福尼亚州欧文市）装置（及其改进型号）进行经心尖经导管主动脉瓣植入术患者的数据。我们分析了术前LVEF与出院时LVEF之间的差异（ΔEF = LVEF术后 - LVEF术前），并将其四分位数间距（±5%）作为临界值。患者分为三组：（1）LVEF改善组（ΔEF≥ +5%）；（2）LVEF不变组（ΔEF -5%至 +5%），以及（3）LVEF恶化组（ΔEF≤ -5%）。采用Kaplan-Meier分析评估生存率，并使用逻辑回归多变量分析确定LVEF改善的独立预测因素。
分析了122例患者的数据。三组患者分布如下：（第1组）27例患者（22.1%），（第2组）69例（56.6%），以及（第3组）26例（21.3%）。第1组的平均ΔEF为12.7%±4.7%，第3组为 -10.8%±3.9%。术前LVEF小于0.35的患者中，ΔEF更有可能改善（p = 0.014）。各组之间在生存率（p = 0.41）、再次住院率（p = 0.472）和纽约心脏协会心功能分级（p = 0.307）方面无显著差异。使用最小可用鞘管（18F）与ΔEF的显著变化无关。
经心尖经导管主动脉瓣植入术后，少数患者的LVEF恶化，但这种变化与术后不良结局无关。LVEF较低的患者改善情况较好。鞘管直径的逐渐减小对LVEF变化无显著影响。
