Aalaei-Andabili Seyed Hossein, Lee Teng C, Waheed Nida, Bavry Anthony A, Petersen John W, Wayangankar Siddharth, Arnaoutakis George J, David Anderson R, Beaver Thomas M
1 Division of Cardiology, Department of Medicine, University of Florida, Gainesville, FL, USA.
2 Division of Thoracic and Cardiovascular Surgery, Department of Surgery, University of Florida, Gainesville, FL, USA.
Innovations (Phila). 2019 Jun;14(3):243-250. doi: 10.1177/1556984519838706. Epub 2019 May 10.
Limited data is available about the effect of implanted valve size on prosthesis-patient mismatch (PPM) incidence and aortic gradient (AG) after transcatheter aortic valve replacement (TAVR) and surgical aortic valve replacement (SAVR). We compared PPM incidence and postprocedural AG between TAVR and SAVR patients considering the impact of implanted valve size.
From March 20, 2012, to September 30, 2015, 563 consecutive patients underwent TAVR ( = 419) or isolated SAVR ( = 144). Postprocedural transthoracic echocardiography was obtained within 30 days; AG, effective orifice area (EOA), and EOA index were calculated.
A total of 381 patients in TAVR group and 82 patients in SAVR group were included. Mean preoperative AG and mean aortic valve area were not significantly different between the 2 groups. Postprocedural AG was significantly lower in TAVR than SAVR group, 7.74 ± 5.39 versus 14.27 ± 8.16 ( < 0.001). Between patients who had TAVR and SAVR with a valve size ≤23 mm, SAVR patients were 3 times more likely to have greater than mild AG after the procedure, OR: 3.1 (95% CI, 1.1 to 8.9) ( < 0.001). PPM incidence was significantly higher in SAVR group than TAVR group, 44 (53.7%) versus 112 (29.4%), OR = 2.8 (95% CI, 1.7 to 4.5) ( < 0.001). The PPM incidence was also higher in SAVR group than TAVR group among those who had the procedures with a valve size ≤23 mm, 35 (64.8%) versus 56 (47.9%), OR = 2 (95% CI, 1.1 to 3.9) ( = 0.048). Postprocedural outcomes were comparable between the 2 groups.
In comparison to SAVR, TAVR is associated with less PPM and lower AG, especially in patients receiving a valve size ≤23 mm.
关于经导管主动脉瓣置换术（TAVR）和外科主动脉瓣置换术（SAVR）后植入瓣膜大小对人工瓣膜-患者不匹配（PPM）发生率和主动脉瓣压差（AG）的影响，目前可用数据有限。我们在考虑植入瓣膜大小影响的情况下，比较了TAVR和SAVR患者的PPM发生率和术后AG。
从2012年3月20日至2015年9月30日，563例连续患者接受了TAVR（n = 419）或单纯SAVR（n = 144）。术后30天内进行经胸超声心动图检查；计算AG、有效瓣口面积（EOA）和EOA指数。
TAVR组共纳入381例患者，SAVR组纳入82例患者。两组术前平均AG和平均主动脉瓣面积无显著差异。TAVR组术后AG显著低于SAVR组，分别为7.74±5.39和14.27±8.16（P < 0.001）。在植入瓣膜大小≤23 mm的TAVR和SAVR患者中，SAVR患者术后AG大于轻度的可能性是TAVR患者的3倍，比值比（OR）：3.1（95%置信区间[CI]，1.1至8.9）（P < 0.001）。SAVR组PPM发生率显著高于TAVR组，分别为44例（53.7%）和112例（29.4%），OR = 2.8（95% CI，1.7至4.5）（P < 0.001）。在植入瓣膜大小≤23 mm的患者中，SAVR组PPM发生率也高于TAVR组，分别为35例（64.8%）和56例（47.9%），OR = 2（95% CI，1.1至3.9）（P = 0.048）。两组术后结局具有可比性。
与SAVR相比，TAVR与更低的PPM发生率和AG相关，尤其是在接受瓣膜大小≤23 mm的患者中。
