Paraggio Lazzaro, Burzotta Francesco, Graziani Francesca, Aurigemma Cristina, Romagnoli Enrico, Pedicino Daniela, Locorotondo Gabriella, Mencarelli Erica, Lillo Rosa, Bruno Piergiorgio, Laezza Domenico, Giambusso Nicole, Lombardo Antonella, Trani Carlo
Institute of Cardiology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italia.
Università Cattolica del Sacro Cuore, Roma, Italia.
Catheter Cardiovasc Interv. 2022 Apr;99(5):1599-1608. doi: 10.1002/ccd.30082. Epub 2022 Jan 18.
The objective of this study is to compare hemodynamic and echocardiographic findings between valve-in-valve (VIV) and native-valve (NV) patients submitted to transcatheter aortic valve implantation (TAVI) due to pure aortic regurgitation (AR).
Patients with severe AR are surgically treated with variable postinterventional left-ventricular (LV) "reverse remodeling." TAVI might be considered in selected AR patients.
Twenty-eight patients with pure severe AR caused by either degenerated bioprosthesis or NV disease were successfully treated by TAVI at our institution. LV catheterization before and after TAVI and echocardiography before, after (24-72 h), and at follow-up (3-12 months) were performed.
Baseline clinical, hemodynamic, and echocardiographic characteristics were comparable between the two study groups, except for a younger age, higher proto-diastolic LV pressure, and higher LV end-systolic diameter in the NV group. At catheterization, an immediate hemodynamic impact of TAVI in both groups was noticed, with a trend toward better postprocedural residual regurgitation index and significantly lower LV dP/dT values (666.0 ± 177.9 vs. 883.5 ± 259.7 mmHg/s, p = 0.04) in VIV. At echocardiography, both NV and VIV patients showed favorable (early and sustained) post-TAVI echocardiographically detectable reverse remodeling. VIV patients also showed more pronounced early reduction in indexed LV end-diastolic volume (68.1 ± 27.4 vs. 86.5 ± 28.9 ml/m in VIV, p < 0.001 and 81.0 ± 29.0 vs. 95.2 ± 37.8 ml/m in NV, p = 0.043).
Successful TAVI induces a striking hemodynamic impact with major structural (reverse remodeling) consequences in patients with pure AR caused by both bioprosthesis degeneration or NV disease. In the immediate postrelease phase, VIV patients might exhibit a more pronounced early LV contractile and structural benefit.
本研究的目的是比较因单纯主动脉瓣反流（AR）接受经导管主动脉瓣植入术（TAVI）的瓣中瓣（VIV）患者和天然瓣膜（NV）患者的血流动力学和超声心动图结果。
重度AR患者接受手术治疗后左心室（LV）“逆向重构”情况各异。部分AR患者可考虑行TAVI。
28例由生物假体退变或NV疾病导致的单纯重度AR患者在我院成功接受TAVI治疗。在TAVI前后进行左心室导管检查，并在TAVI前、后（24 - 72小时）及随访（3 - 12个月）时进行超声心动图检查。
除NV组年龄较小、舒张前期左心室压力较高和左心室收缩末期直径较大外，两个研究组的基线临床、血流动力学和超声心动图特征具有可比性。在导管检查时，注意到TAVI对两组均有即刻血流动力学影响，VIV组术后残余反流指数有改善趋势，且左心室dP/dT值显著更低（666.0±177.9 vs. 883.5±259.7 mmHg/s，p = 0.04）。在超声心动图检查中，NV组和VIV组患者在TAVI后均显示出良好的（早期和持续的）超声心动图可检测到的逆向重构。VIV组患者还显示出左心室舒张末期容积指数早期更明显的降低（VIV组为68.1±27.4 vs. 86.5±28.9 ml/m²，p < 0.001；NV组为81.0±29.0 vs. 95.2±37.8 ml/m²，p = 0.043）。
成功的TAVI对由生物假体退变或NV疾病导致的单纯AR患者具有显著的血流动力学影响，并产生主要的结构（逆向重构）后果。在释放后的即刻阶段，VIV组患者可能表现出更明显的早期左心室收缩和结构获益。
