比较自膨式 RDV Perceval S 与 TAVI ACURATE neo/TF。
Comparison of Self-Expanding RDV Perceval S versus TAVI ACURATE neo/TF.
机构信息
Department of Cardiothoracic Surgery, Heart Center, University Hospital of Cologne, Cologne, Germany.
Department of Cardiology, Heart Center, University Hospital of Cologne, Cologne, Germany.
出版信息
Thorac Cardiovasc Surg. 2021 Aug;69(5):420-427. doi: 10.1055/s-0040-1722692. Epub 2021 Mar 24.
BACKGROUND
Rapid deployment aortic valve replacement (RDAVR) and transcatheter aortic valve implantation (TAVI) have emerged as increasingly used alternatives to conventional aortic valve replacement to treat patients at higher surgical risk. Therefore, in this single-center study, we retrospectively compared clinical outcomes and hemodynamic performance of two self-expanding biological prostheses, the sutureless and rapid deployment valve (RDV) Perceval-S (PER) and the transcatheter heart valve (THV) ACURATE /TF (NEO) in a 1:1 propensity-score-matching (PSM) patient cohort.
METHODS
A total of 332 consecutive patients with symptomatic aortic valve stenosis underwent either singular RDAVR with PER (119) or TAVI with NEO (213) at our institutions between 2012 and 2017. To compare the unequal patient groups, a 1:1 PSM for preoperative data and comorbidities was conducted. Afterward, 59 patient pairs were compared with regard to relevant hemodynamic parameter, relevant paravalvular leak (PVL), permanent postoperative pacemaker (PPM) implantation rate, and clinical postoperative outcomes.
RESULTS
Postoperative clinical short-term outcomes presented with slightly higher rates for 30-day all-cause mortality (PER = 5.1% vs. NEO = 1.7%, = 0.619) and major adverse cardiocerebral event in PER due to cerebrovascular events (transient ischemic attack [TIA]-PER = 3.4% vs. TIA-NEO = 1.7%, = 0.496 and Stroke-PER = 1.7% vs. Stroke-NEO = 0.0%, = 1). Moreover, we show comparable PPM rates (PER = 10.2% vs. NEO = 8.5%, = 0.752). However, higher numbers of PVL (mild-PER = 0.0% vs. NEO = 55.9%, = 0.001; moderate or higher-PER = 0.0% vs. NEO = 6.8%, = 0.119) after TAVI with NEO were observed.
CONCLUSION
Both self-expanding bioprostheses, the RDV-PER and THV-NEO provide a feasible option in elderly and patients with elevated perioperative risk. However, the discussed PER collective showed more postoperative short-term complications with regard to 30-day all-cause mortality and cerebrovascular events, whereas the NEO showed higher rates of PVL.
背景
主动脉瓣置换术的快速部署（RDAVR）和经导管主动脉瓣植入术（TAVI）已成为治疗手术风险较高的患者的替代传统主动脉瓣置换术的越来越受欢迎的方法。因此，在这项单中心研究中，我们回顾性比较了两种自膨式生物瓣膜，即无缝线和快速部署瓣膜（RDV）Perceval-S（PER）和经导管心脏瓣膜（THV）ACURATE / TF（NEO）在 1:1 倾向评分匹配（PSM）患者队列中的临床结果和血流动力学性能。
方法
2012 年至 2017 年间，我院共有 332 例有症状的主动脉瓣狭窄患者接受了单一的 RDAVR 治疗（PER，119 例）或 TAVI 治疗（NEO，213 例）。为了比较不等同的患者组，对术前数据和合并症进行了 1:1 PSM。之后，比较了 59 对患者的相关血流动力学参数、相关瓣周漏（PVL）、永久性术后起搏器（PPM）植入率和临床术后结果。
结果
术后短期临床结果显示，PER 的 30 天全因死亡率（PER=5.1%，NEO=1.7%，=0.619）和 PER 中的主要不良心脑血管事件（由于脑血管事件，短暂性脑缺血发作（TIA）-PER=3.4%，TIA-NEO=1.7%，=0.496 和中风-PER=1.7%，NEO=0.0%，=1）稍高。此外，我们还显示出相似的 PPM 率（PER=10.2%，NEO=8.5%，=0.752）。然而，NEO 组的 PVL 发生率较高（轻度-PER=0.0%，NEO=55.9%，=0.001；中度或更高-PER=0.0%，NEO=6.8%，=0.119）。
结论
两种自膨式生物瓣膜，即 RDV-PER 和 THV-NEO，为老年患者和围手术期风险较高的患者提供了可行的选择。然而，讨论中的 PER 组在 30 天全因死亡率和脑血管事件方面表现出更多的术后短期并发症，而 NEO 组的 PVL 发生率较高。
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