Division of Cardiology, Department of Internal Medicine, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Korea.
Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea.
Yonsei Med J. 2020 Jan;61(1):30-39. doi: 10.3349/ymj.2020.61.1.30.
We aimed to compare the effect of transcatheter aortic valve replacement (TAVR) and surgical aortic valve replacement (sAVR) on recovery of left ventricular (LV) diastolic function and afterload through serial echocardiographic examinations in patients with symptomatic high-risk severe aortic stenosis during early follow-up.
We included 38 patients undergoing TAVR (mean age, 80±6 years; male:female=18:20) and 27 patients undergoing sAVR (mean age, 78±3 years; male:female=12:15). We compared changes in the LV diastolic function and afterload before, immediately after, and 3 months after the procedure using serial transthoracic echocardiography.
Immediately after the procedure, 16 (42%) and 3 (11%) patients in the TAVR and sAVR groups, respectively, showed rapid improvement in diastolic filling patterns. E wave to e' ratio (E/e') and right ventricular systolic pressure (RVSP) decreased significantly in the TAVR group (E/e': TAVR, from 24.6±12.9 to 20±9.5, =0.048 vs. sAVR, from 21.5±9.4 to 20.64±6.4, =0.361; RVSP: TAVR, 38.4±17.2 vs. 34±12.4, =0.032 vs. sAVR, 32.2±11.7 vs. 30±6.8, =0.27). After 3 months, diastolic grade distribution, E/e', and RVSP were similar. Valvuloarterial impedance significantly decreased immediately after the procedure in both groups (TAVR, from 5.1±1.4 to 3.1±1.0 vs. sAVR, from 4.5±1.5 to 3.1±0.8 mm Hg · mL⁻¹ · m⁻², =0.001), but after 3 months, decreases were greater in the sAVR group (from 3.1±0.8 to 2.2±1.5 mm Hg · mL⁻¹ · m⁻², =0.093).
LV diastolic function improved more rapidly and earlier in patients treatment with TAVR than in patients treated with sAVR. These results might explicate the remarkable clinical improvement in improvements in advanced diastolic dysfunction immediately after the TAVR procedure than sAVR.
我们旨在通过对接受经导管主动脉瓣置换术（TAVR）和外科主动脉瓣置换术（sAVR）的高危重度主动脉瓣狭窄患者的早期随访中连续进行超声心动图检查，比较 TAVR 和 sAVR 对左心室（LV）舒张功能和后负荷恢复的影响。
我们纳入了 38 例接受 TAVR（平均年龄 80±6 岁；男：女=18:20）和 27 例接受 sAVR（平均年龄 78±3 岁；男：女=12:15）的患者。我们使用连续经胸超声心动图比较了术前、术后即刻和术后 3 个月时 LV 舒张功能和后负荷的变化。
术后即刻，TAVR 组和 sAVR 组分别有 16 例（42%）和 3 例（11%）患者的舒张充盈模式迅速改善。TAVR 组的 E 波与 e'波比值（E/e'）和右心室收缩压（RVSP）显著降低（E/e'：TAVR，从 24.6±12.9 降至 20±9.5，=0.048 与 sAVR，从 21.5±9.4 降至 20.64±6.4，=0.361；RVSP：TAVR，从 38.4±17.2 降至 34±12.4，=0.032 与 sAVR，从 32.2±11.7 降至 30±6.8，=0.27）。术后 3 个月时，舒张分级分布、E/e'和 RVSP 相似。术后即刻两组的脉压阻抗均显著降低（TAVR，从 5.1±1.4 降至 3.1±1.0 与 sAVR，从 4.5±1.5 降至 3.1±0.8 mm Hg·mL⁻¹·m⁻²，=0.001），但术后 3 个月时 sAVR 组的降幅更大（从 3.1±0.8 降至 2.2±1.5 mm Hg·mL⁻¹·m⁻²，=0.093）。
与 sAVR 相比，TAVR 治疗的患者 LV 舒张功能改善更快、更早。这些结果可能解释了 TAVR 术后早期晚期舒张功能障碍的显著临床改善。
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