Shah Binita, McDonald Daniel, Paone Darien, Redel-Traub Gabriel, Jangda Umair, Guo Yu, Saric Muhamed, Donnino Robert, Staniloae Cezar, Robin Tonya, Benenstein Ricardo, Vainrib Alan, Williams Mathew R
Department of Medicine, Division of Cardiology, Veterans Affairs New York Harbor Health System and New York University (NYU) School of Medicine, New York, New York.
Department of Medicine, Division of Cardiology, NYU School of Medicine, New York, New York.
J Interv Cardiol. 2018 Dec;31(6):849-860. doi: 10.1111/joic.12561. Epub 2018 Sep 10.
Transcatheter aortic valve replacement (TAVR) for low gradient (LG) severe aortic stenosis (AS) with preserved left ventricular ejection fraction (LVEF) remains an area of clinical uncertainty.
Retrospective review identified 422 patients who underwent TAVR between September 4, 2014 and July 1, 2016. Procedural indication other than severe AS (n = 22) or LVEF <50% (n = 98) were excluded. Outcomes were defined by valve academic research consortium two criteria when applicable and compared between LG (peak velocity <4.0 m/s and mean gradient <40 mmHg; n = 73) and high gradient (HG) (n = 229) groups. The LG group was further categorized as low stroke volume index (SVI) (n = 41) or normal SVI (n = 32). Median follow-up was 747 days [interquartile range 220-1013].
Baseline thirty-day mortality risk (LG 6.2% [3.8-8.1] vs HG 5.7% [4.1-7.4], P = 0.43) did not differ between groups. Short-term outcomes, including procedural success rate (86.1% vs 88.8%, P = 0.53), peri-procedural complications (intra-procedural heart block: 6.8% vs 7.9%, P = 0.99; permanent pacemaker placement: 11.0% vs 13.6%, P = 0.69; moderate paravalvular regurgitation: 2.7% vs 1.3%, P = 0.60), and all-cause in-hospital mortality (2.7% vs 0.9%, P = 0.25) did not differ between LG and HG groups. On long-term follow-up, all-cause mortality also did not differ between LG and HG groups (6.8% vs 10.0%, p = 0.33) or between the LG low SVI (9.8%), LG normal SVI (3.1%), and HG (10.0%) groups (p = 0.39).
Patients with preserved LVEF undergoing TAVR for severe AS with LG, including LG with low SVI, have no significant difference in adverse outcomes when compared to patients with HG.
对于左心室射血分数（LVEF）保留的低梯度（LG）重度主动脉瓣狭窄（AS）患者，经导管主动脉瓣置换术（TAVR）仍是一个临床存在不确定性的领域。
回顾性分析确定了2014年9月4日至2016年7月1日期间接受TAVR的422例患者。排除除重度AS（n = 22）或LVEF<50%（n = 98）以外的手术指征。适用时，根据瓣膜学术研究联盟二标准定义结局，并在LG（峰值速度<4.0 m/s且平均梯度<40 mmHg；n = 73）和高梯度（HG）（n = 229）组之间进行比较。LG组进一步分为低每搏量指数（SVI）（n = 41）或正常SVI（n = 32）。中位随访时间为747天[四分位间距220 - 1013]。
两组间30天基线死亡风险无差异（LG组6.2%[3.8 - 8.1] vs HG组5.7%[4.1 - 7.4]，P = 0.43）。短期结局，包括手术成功率（86.1% vs 88.8%，P = 0.53）、围手术期并发症（术中心脏传导阻滞：6.8% vs 7.9%，P = 0.99；永久性起搏器植入：11.0% vs 13.6%，P = 0.69；中度瓣周反流：2.7% vs 1.3%，P = 0.60）以及全因住院死亡率（2.7% vs 0.9%，P = 0.25）在LG组和HG组之间无差异。在长期随访中，LG组和HG组之间的全因死亡率也无差异（6.8% vs 10.0%，p = 0.33），LG低SVI组（9.8%）、LG正常SVI组（3.1%）和HG组（10.0%）之间也无差异（p = 0.
