Shishido Koki, Yamanaka Futoshi, Ochiai Tomoki, Yamabe Tsuyoshi, Noguchi Kenichiro, Ota Takashi, Koide Yasuhiro, Ogino Hidemitsu, Tanaka Yutaka, Saito Shigeru
Department of Cardiology, Shonan Kamakura General Hospital, Okamoto 1370-1, Kamakura, 247-8533, Japan.
Department of Cardiovascular Surgery, Shonan Kamakura General Hospital, Kamakura, Japan.
Heart Vessels. 2019 Oct;34(10):1674-1683. doi: 10.1007/s00380-019-01414-0. Epub 2019 Apr 16.
Transcatheter aortic valve implantation (TAVI) is a viable treatment option for high-risk patients with severe aortic stenosis. In Japan, TAVI can be performed using first-generation self-expandable Medtronic CoreValve or balloon-expandable Edwards SAPIEN-XT from 2012. Since the durability and hemodynamic outcomes after transcatheter heart valve (THV) implantation in Japanese patients have not been clearly elucidated, we assessed serial changes in post-TAVI THV performances over a-3-year period by transthoracic echocardiography (TTE). From January 2012 to September 2014, among 83 patients with severe aortic stenosis, 26 underwent TAVI with CoreValve and 57 underwent TAVI with SAPIEN-XT. We assessed the serial changes in first post-implant (FPI) and 3-year post procedure THV hemodynamics by TTE. Valve performance was evaluated by serial assessment of aortic valve mean pressure gradient (PG) and aortic valve area (AVA) assessments. Three-year clinical outcomes were compared between the patients with CoreValve and those with SAPIEN-XT. Seventeen patients with CoreValve and 34 patients with SAPIEN-XT had FPI and 3-year TTEs. The AVA decreased significantly from FPI to 3-year follow-up among patients with SAPIEN-XT, but not among patients with CoreValve. The mean aortic PG decreased significantly from FPI to the 3-year follow-up point among patients with CoreValve; however, it was not significantly different from those with SAPIEN-XT. The absolute change in mean PG from FPI to the 3-year follow-up point decreased significantly among those with CoreValve compared to those with SAPIEN-XT. Clinical outcomes after TAVI were similar for both devices at 3-years after TAVI. In this study, long-term clinical outcomes for CoreValve and SAPIEN XT were similar. The 3-year THV performance of both devices was maintained after TAVI. Serial change in mean aortic PGs for CoreValve decreases significantly from FPI to the 3-year follow-up point compared to that for SAPIEN-XT.
经导管主动脉瓣植入术（TAVI）是治疗高危重度主动脉瓣狭窄患者的一种可行选择。在日本，自2012年起可使用第一代自膨胀式美敦力CoreValve或球囊扩张式爱德华兹SAPIEN-XT进行TAVI。由于日本患者经导管心脏瓣膜（THV）植入后的耐久性和血流动力学结果尚未明确阐明，我们通过经胸超声心动图（TTE）评估了TAVI术后3年内THV性能的系列变化。2012年1月至2014年9月，在83例重度主动脉瓣狭窄患者中，26例接受了CoreValve TAVI，57例接受了SAPIEN-XT TAVI。我们通过TTE评估了首次植入后（FPI）和术后3年THV的血流动力学系列变化。通过对主动脉瓣平均压力阶差（PG）和主动脉瓣面积（AVA）的系列评估来评价瓣膜性能。比较了CoreValve组和SAPIEN-XT组患者的3年临床结局。17例CoreValve患者和34例SAPIEN-XT患者进行了FPI和3年TTE检查。SAPIEN-XT组患者从FPI到3年随访期间AVA显著降低，而CoreValve组患者则未降低。CoreValve组患者从FPI到3年随访点的平均主动脉PG显著降低；然而，与SAPIEN-XT组患者相比无显著差异。与SAPIEN-XT组相比，CoreValve组从FPI到3年随访点平均PG的绝对变化显著降低。TAVI术后3年，两种装置的临床结局相似。在本研究中，CoreValve和SAPIEN XT的长期临床结局相似。TAVI术后两种装置的3年THV性能均得以维持。与SAPIEN-XT相比，CoreValve从FPI到3年随访点平均主动脉PG的系列变化显著降低。
