Kanso Mohamad, Kibler Marion, Hess Sebastien, Rischner Jérome, Plastaras Philoktimon, Kindo Michel, Hoang Minh, De Poli Fabien, Leddet Pierre, Petit Hélène, Zeyons Floriane, Trinh Annie, Matsushita Kensuke, Morel Olivier, Ohlmann Patrick
Pôle d'Activité Médico-Chirurgicale Cardiovasculaire, Hôpitaux Universitaires de Strasbourg, 67000 Strasbourg, France.
Hôpital Albert Schweitzer, 201 Avenue d'Alsace, 68003 Colmar, France.
J Clin Med. 2021 Jan 7;10(2):186. doi: 10.3390/jcm10020186.
Published data on the size-specific effective orifice area (EOA) of transcatheter heart valves (THVs) remain scarce. Here, we sought to investigate the intra-individual changes in EOA and mean transvalvular aortic gradient (MG) of the Sapien 3 (S3), CoreValve (CV), and Evolut R (EVR) prostheses both at short-term and at 1-year follow-up. The study sample consisted of 260 consecutive patients with severe aortic stenosis who underwent transcatheter aortic valve implantation (TAVI). EOAs and MGs were measured with Doppler echocardiography for the following prostheses: S3 23 mm ( = 74; 28.5%), S3 26 mm ( = 67; 25.8%), S3 29 mm ( = 20; 7.7%), CV 23 mm ( = 2; 0.8%), CV 26 mm ( = 15; 5.8%), CV 29 mm ( = 24; 9.2%), CV 31 mm ( = 9; 3.5%), EVR 26 mm ( = 22; 8.5%), and EVR 29 mm ( = 27; 10.4%). Values were obtained at discharge, 1 month, 6 months, and 1 year from implantation. At discharge, EOAs were larger and MGs lower for larger-size prostheses, regardless of being balloon-expandable or self-expandable. In patients with small aortic annulus size, the hemodynamic performances of CV and EVR prostheses were superior to those of S3. However, we did not observe significant differences in terms of all-cause mortality according to THV type or size. Both balloon-expandable and self-expandable new-generation THVs show excellent hemodynamic performances without evidence of very early valve degeneration.
关于经导管心脏瓣膜（THV）特定尺寸有效瓣口面积（EOA）的已发表数据仍然很少。在此，我们试图研究Sapien 3（S3）、CoreValve（CV）和Evolut R（EVR）假体在短期和1年随访时EOA和平均跨瓣主动脉梯度（MG）的个体内变化。研究样本包括260例连续接受经导管主动脉瓣植入术（TAVI）的严重主动脉瓣狭窄患者。通过多普勒超声心动图测量以下假体的EOA和MG：S3 23 mm（n = 74；28.5%）、S3 26 mm（n = 67；25.8%）、S3 29 mm（n = 20；7.7%）、CV 23 mm（n = 2；0.8%）、CV 26 mm（n = 15；5.8%）、CV 29 mm（n = 24；9.2%）、CV 31 mm（n = 9；3.5%）、EVR 26 mm（n = 22；8.5%）和EVR 29 mm（n = 27；10.4%）。在植入后出院时、1个月、6个月和1年获取数值。出院时，无论为球囊扩张式还是自膨胀式，较大尺寸假体的EOA更大且MG更低。在主动脉瓣环尺寸较小的患者中，CV和EVR假体的血流动力学性能优于S3。然而，我们未观察到根据THV类型或尺寸在全因死亡率方面存在显著差异。球囊扩张式和自膨胀式新一代THV均显示出优异的血流动力学性能，且无非常早期瓣膜退变的证据。
