Didier Romain, Benic Clément, Nasr Bahaa, Le Ven Florent, Hannachi Sinda, Eltchaninoff Hélène, Koifman Edward, Donzeau-Gouge Patrick, Fajadet Jean, Leprince Pascal, Leguerrier Alain, Lièvre Michel, Prat Alain, Teiger Emmanuel, Lefevre Thierry, Cuisset Thomas, Le Breton Herve, Auffret Vincent, Iung Bernard, Gilard Martine
Department of Cardiology, University Hospital of Brest, 29200 Brest, France.
Cardiology Service, Rouen-Charles-Nicolle University Hospital Center, National Institute of Health and Medical Research U644, 76000 Rouen, France.
J Clin Med. 2021 Jul 22;10(15):3221. doi: 10.3390/jcm10153221.
Mean Gradient (MG) elevation can be detected immediately after transcatheter aortic valve implantation (TAVI) or secondarily during follow-up. Comparisons and interactions between these two parameters and their impact on outcomes have not previously been investigated. This study aimed to identify incidence, influence on prognosis, and parameters associated with immediate high post-procedural mean transvalvular gradient (PPMG) and delayed mean gradient increase (6 to 12 months after TAVI, DMGI) in the FRANCE 2 (French Aortic National CoreValve and Edwards 2) registry. The registry includes all consecutive symptomatic patients with severe aortic stenosis who have undergone TAVI. Three groups were analyzed: (1) PPMG < 20 mmHg without DMGI > 10 mmHg (control); (2) PPMG < 20 mmHg with DMGI > 10 mmHg (Group 1); and (3) PPMG ≥ 20 mmHg (Group 2). From January 2010 to January 2012, 4201 consecutive patients were prospectively enrolled in the registry. Controls comprised 2078 patients. In Group 1( = 131 patients), DMGI exceeded 10 mmHg in 5.6%, and was not associated with greater 4-years mortality than in controls (32.6% vs. 40.1%, = 0.27). In Group 2 ( = 144 patients), PPMG was at least 20 mmHg in 6.1% and was associated with higher 4-year mortality (48.7% versus 40.1%, = 0.005). A total of two-thirds of the patients with PPMG ≥ 20 mmHg had MG < 20 mmHg at 1 year, with mortality similar to the controls (39.2% vs. 40.1%, = 0.73). Patients with PPMG > 20 mmHg 1 year post-TAVI had higher 4-years mortality than the general population of the registry, unlike patients with MG normalization.
经导管主动脉瓣植入术（TAVI）后可立即检测到平均梯度（MG）升高，或在随访期间继发出现。此前尚未对这两个参数之间的比较和相互作用及其对预后的影响进行研究。本研究旨在确定法国2（法国主动脉国家CoreValve和爱德华兹2）注册研究中即刻术后高平均跨瓣梯度（PPMG）和延迟平均梯度增加（TAVI后6至12个月，DMGI）的发生率、对预后的影响以及相关参数。该注册研究纳入了所有接受TAVI的连续性有症状重度主动脉瓣狭窄患者。分析了三组：（1）PPMG<20 mmHg且DMGI>10 mmHg（对照组）；（2）PPMG<20 mmHg且DMGI>10 mmHg（第1组）；（3）PPMG≥20 mmHg（第2组）。2010年1月至2012年1月，共有4201例连续性患者前瞻性纳入该注册研究。对照组包括2078例患者。在第1组（n = 131例患者）中，5.6%的患者DMGI超过10 mmHg，且与4年死亡率高于对照组无关（32.6%对40.1%，P = 0.27）。在第2组（n = 144例患者）中，6.1%的患者PPMG至少为20 mmHg，且与4年较高死亡率相关（48.7%对40.1%，P = 0.005）。PPMG≥20 mmHg的患者中，共有三分之二在1年时MG<20 mmHg，死亡率与对照组相似（39.2%对40.1%，P = 0.73）。TAVI术后1年PPMG>20 mmHg的患者4年死亡率高于注册研究的总体人群，与MG恢复正常的患者不同。
