Division of Cardiovascular Medicine, Mayo Clinic and Mayo Foundation, Rochester, Minnesota.
Division of Cardiothoracic Surgery, Mayo Clinic and Mayo Foundation, Rochester, Minnesota.
Catheter Cardiovasc Interv. 2019 Nov 1;94(5):738-744. doi: 10.1002/ccd.28074. Epub 2019 Jan 27.
The effect of utilizing transapical (TA) access for transcatheter aortic valve replacement (TAVR) on cardiac function has not been well studied.
The aim of this retrospective study is to determine the direct effects of TA access for TAVR on myocardial function parameters and their correlation with 4-year survival.
Three hundred and thirty propensity matched patients, who underwent TAVR using Sapien valve (Edwards Lifesciences Corp, Irvine, CA) between February 15, 2012 and June 17, 2016 (115 TA and 115 transfemoral [TF] routes) were studied. The pre- and 1 month post-TAVR echocardiographic features of both groups were compared. The 4-year survival in both groups was analyzed.
Baseline clinical characteristics, diastolic function parameters, left ventricular (LV) chamber size, and ejection fraction were similar between matched TA and TF groups. At 1 month following TAVR, there was a significant increase in stroke volume index (SVI) in both TA (mean increase 7 cm /m ; P = 0.03) and TF groups (mean increase 7 cm /m ; P < 0.001). Left ventricular ejection fraction (LVEF) significantly increased post TF TAVR (mean increase 2%; P = 0.008), but no significant increase was observed post TA TAVR (mean increase 1%; P = 0.27). Both groups had significant improvement in aortic valve (AV) hemodynamics post-TAVR (P < 0.001). Overall, there were no significant differences in the mean change of SVI, LVEF, or left ventricular end diastolic dimensions (LVEDDs) post TA versus TF TAVR. There was no significant difference in 4-year survival in the TF compared to TA group (49% vs 50%, P = 0.43).
Both TA and TF TAVR were equally associated with favorable changes in LV SVI and AV hemodynamics in 30 days. TA TAVR patients had similar 4 year survival to propensity matched TF TAVR; therefore, TA TAVR remains an acceptable alternative access route in patients not amenable to TF TAVR.
经心尖（TA）入路行经导管主动脉瓣置换术（TAVR）对心功能的影响尚未得到很好的研究。
本回顾性研究旨在确定 TA 入路行 TAVR 对心肌功能参数的直接影响及其与 4 年生存率的相关性。
研究纳入 2012 年 2 月 15 日至 2016 年 6 月 17 日期间接受 Sapien 瓣膜（爱德华生命科学公司，欧文，加利福尼亚州）TAVR 的 330 例经倾向评分匹配的患者（TA 组 115 例，经股动脉[TF]组 115 例）。比较两组患者 TAVR 前后 1 个月的超声心动图特征。分析两组患者的 4 年生存率。
匹配的 TA 和 TF 组患者的基线临床特征、舒张功能参数、左心室（LV）腔大小和射血分数相似。TAVR 后 1 个月，TA（平均增加 7cm /m；P=0.03）和 TF 组（平均增加 7cm /m；P<0.001）的每搏输出量指数（SVI）均显著增加。TF 组 TAVR 后左心室射血分数（LVEF）显著增加（平均增加 2%；P=0.008），但 TA 组 TAVR 后无显著增加（平均增加 1%；P=0.27）。两组主动脉瓣（AV）血流动力学均有显著改善（P<0.001）。总的来说，TA 与 TF 组 TAVR 后 SVI、LVEF 或左心室舒张末期内径（LVEDD）的平均变化无显著差异。TF 组与 TA 组 4 年生存率无显著差异（49%与 50%，P=0.43）。
TA 和 TF 组 TAVR 均在 30 天内导致 LV SVI 和 AV 血流动力学的有利变化。TA 组 TAVR 患者的 4 年生存率与倾向性匹配的 TF 组 TAVR 患者相似；因此，TA 组 TAVR 仍然是不能接受 TF TAVR 的患者的一种可接受的替代入路。
