经导管主动脉瓣置换术（TAVI）使用 SAPIEN 3 后亚洲人种假体-患者不匹配的发生率和预测因素：新型和旧型球囊扩张瓣膜之间的差异。
Incidence and predictors of prosthesis-patient mismatch after TAVI using SAPIEN 3 in Asian: differences between the newer and older balloon-expandable valve.
机构信息
Cardiovascular Center, Sendai Kosei Hospital, Sendai, Miyagi, Japan
Cardiovascular Center, Sendai Kosei Hospital, Sendai, Miyagi, Japan.
出版信息
Open Heart. 2021 Mar;8(1). doi: 10.1136/openhrt-2020-001531.
BACKGROUND
The balloon-expandable SAPIEN 3 (S3) is superior to the older-generation balloon-expandable SAPIEN XT (XT) in a lower incidence of paravalvular aortic regurgitation, lower complication rates and better survival in transcatheter aortic valve implantation (TAVI). However, prosthesis-patient mismatch (PPM) more frequently occurs in S3 than XT. Further, little information is available on PPM after TAVI using S3 in Asians. This study aims to determine the incidence and predictors of PPM in S3 by focusing on the difference between S3 and XT using data from a Japanese multicentre registry.
METHODS
From the Optimised transCathEter vAlvular iNtervention-TAVI (OCEAN-TAVI) registry, 2134 patients undergoing TAVI using S3 or XT were included. PPM was defined as moderate if ≧0.65 but ≦0.85 cm/m or severe if <0.65 cm/m at the indexed effective orifice area by postprocedural echocardiography.
RESULTS
The incidence of moderate and severe PPM in S3 was 13.3% and 1.3%, respectively. The 20 mm transcatheter heart valve (THV) was more frequently used in S3 than XT (7.4% vs 2.4%, p<0.0001). PPM was more frequently observed in S3 than XT (14.7% vs 8.8%, p<0.0001). Multivariate logistic regression analysis revealed S3 predicted PPM (OR 1.92 (95% CI 1.35 to 2.74), p=0.0003). The mutual predictors for PPM between S3 and XT were younger age, larger body surface area, smaller aortic valve area, no balloon postdilatation and the use of 20 mm and 23 mm THV. When comparing 23 mm, 26 mm and 29 mm S3, the ORs of 20 mm S3 were 5.67 (95% CI 2.88 to 11.12), 19.24 (95% CI 8.13 to 46.86) and 51.03 (95% CI 12.28 to 280.77), respectively.
CONCLUSIONS
The incidence of PPM after TAVI using S3 was 14.6% overall in this Asian population. PPM was more frequently observed in S3 than XT. A considerable number of patients were treated by the 20 mm S3 in an Asian cohort. The 20 mm THV was identified as a strong predictor for PPM.
背景
在经导管主动脉瓣置换术（TAVI）中，球囊扩张的 SAPIEN 3（S3）与较老一代的球囊扩张 SAPIEN XT（XT）相比，发生瓣周漏的几率更低、并发症发生率更低、生存率更高。然而，S3 比 XT 更容易发生假体-患者不匹配（PPM）。此外，关于在亚洲人群中使用 S3 进行 TAVI 后 PPM 的信息很少。本研究旨在通过关注 S3 和 XT 之间的差异，利用来自日本多中心登记处的数据，确定 S3 中 PPM 的发生率和预测因素。
方法
从优化的经导管瓣膜介入术- TAVI（OCEAN-TAVI）登记处中，纳入了 2134 例使用 S3 或 XT 进行 TAVI 的患者。术后超声心动图提示有效瓣口面积指数处存在中度 PPM（≧0.65 但 ≦0.85 cm/m）或重度 PPM（<0.65 cm/m）时定义为 PPM。
结果
S3 中度和重度 PPM 的发生率分别为 13.3%和 1.3%。S3 中 20 毫米经导管心脏瓣膜（THV）的使用率高于 XT（7.4%比 2.4%，p<0.0001）。S3 中 PPM 的发生率高于 XT（14.7%比 8.8%，p<0.0001）。多变量逻辑回归分析显示，S3 预测 PPM（OR 1.92（95% CI 1.35 至 2.74），p=0.0003）。S3 和 XT 之间发生 PPM 的共同预测因素为年龄较小、体表面积较大、主动脉瓣面积较小、无球囊后扩张以及使用 20 毫米和 23 毫米 THV。当比较 23 毫米、26 毫米和 29 毫米 S3 时，20 毫米 S3 的 OR 分别为 5.67（95% CI 2.88 至 11.12）、19.24（95% CI 8.13 至 46.86）和 51.03（95% CI 12.28 至 280.77）。
结论
在这个亚洲人群中，总体而言，使用 S3 进行 TAVI 后 PPM 的发生率为 14.6%。S3 中 PPM 的发生率高于 XT。在亚洲队列中，相当一部分患者接受了 20 毫米 S3 的治疗。20 毫米 THV 被确定为 PPM 的一个强预测因素。
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