Daubert Melissa A, Weissman Neil J, Hahn Rebecca T, Pibarot Philippe, Parvataneni Rupa, Mack Michael J, Svensson Lars G, Gopal Deepika, Kapadia Samir, Siegel Robert J, Kodali Susheel K, Szeto Wilson Y, Makkar Raj, Leon Martin B, Douglas Pamela S
Duke University Medical Center, Duke Clinical Research Institute, Durham, North Carolina.
MedStar Health Research Institute, Washington, DC.
JACC Cardiovasc Imaging. 2016 Dec 8. doi: 10.1016/j.jcmg.2016.11.004.
The aim of this study was to evaluate the long-term performance of transcatheter aortic valve replacement (TAVR) and surgical aortic valve replacement (SAVR) through longitudinal echocardiographic analysis.
The long-term performance of the SAPIEN TAVR is not well-described. Therefore, we examined the hemodynamic and valvular profile of the SAPIEN TAVR over 5 years.
All patients receiving TAVR or SAVR with first post-implant (FPI) and 5-year echoes were analyzed for aortic valve (AV) peak velocity, AV mean gradient, AV area, peak left ventricular (LV) outflow tract and in-stent velocities, Doppler velocity index, aortic regurgitation (AR), LV mass index, stroke volume index, and cardiac index. The FPI and 5-year data were compared using a paired t test or McNemar's analyses.
There were 86 TAVR and 48 SAVR patients with paired FPI and 5-year echocardiograms. Baseline characteristics were similar between groups. The AV area did not change significantly 5 years after TAVR (p = 0.35). The AV mean gradient also remained stable: 11.5 ± 5.4 mm Hg at FPI to 11.0 ± 6.3 mm Hg at 5 years (p = 0.41). In contrast, the peak AV and LV outflow tract velocities decreased (p = 0.03 and p = 0.008, respectively), as did in-stent velocity (p = 0.015). Correspondingly, the TAVR Doppler velocity index was unchanged (p = 0.07). Among TAVR patients, there was no change in total AR (p = 0.40), transvalvular AR (p = 0.37), or paravalvular AR (p = 0.26). Stroke volume index and cardiac index remained stable (p = 0.16 and p = 0.25, respectively). However, there was a significant regression of LV mass index (p < 0.0001). The longitudinal evaluation among SAVR patients revealed similar trends. There was a low rate of adverse events among TAVR and SAVR patients alive at 5 years.
Longitudinal assessment of the PARTNER I trial (THE PARTNER TRIAL: Placement of AoRTic TraNscathetER Valve Trial) demonstrates that valve performance and cardiac hemodynamics are stable after implantation in both SAPIEN TAVR and SAVR in patients alive at 5 years. (THE PARTNER TRIAL: Placement of AoRTic TraNscathetER Valve Trial; NCT00530894).
本研究旨在通过纵向超声心动图分析评估经导管主动脉瓣置换术（TAVR）和外科主动脉瓣置换术（SAVR）的长期性能。
SAPIEN TAVR的长期性能尚未得到充分描述。因此，我们对SAPIEN TAVR超过5年的血流动力学和瓣膜情况进行了研究。
对所有接受TAVR或SAVR且有首次植入后（FPI）及5年超声心动图检查的患者，分析其主动脉瓣（AV）峰值速度、AV平均压差、AV面积、左心室（LV）流出道峰值及支架内速度、多普勒速度指数、主动脉瓣反流（AR）、LV质量指数、每搏量指数和心脏指数。使用配对t检验或McNemar分析比较FPI和5年的数据。
有86例接受TAVR和48例接受SAVR的患者有配对的FPI和5年超声心动图。两组间基线特征相似。TAVR术后5年AV面积无显著变化（p = 0.35）。AV平均压差也保持稳定：FPI时为11.5±5.4 mmHg，5年时为11.0±6.3 mmHg（p = 0.41）。相比之下，AV和LV流出道峰值速度降低（分别为p = 0.03和p = 0.008），支架内速度也降低（p = 0.015）。相应地，TAVR多普勒速度指数无变化（p = 0.07）。在TAVR患者中，总AR（p = 0.40）、经瓣AR（p = 0.37）或瓣周AR（p = 0.26）均无变化。每搏量指数和心脏指数保持稳定（分别为p = 0.16和p = 0.25）。然而，LV质量指数有显著下降（p < 0.0001）。SAVR患者的纵向评估显示出相似趋势。5年存活的TAVR和SAVR患者不良事件发生率较低。
PARTNER I试验（PARTNER试验：主动脉经导管瓣膜置入试验）的纵向评估表明，对于5年存活的患者，SAPIEN TAVR和SAVR植入术后瓣膜性能和心脏血流动力学均稳定。（PARTNER试验：主动脉经导管瓣膜置入试验；NCT00530894）
