Ferrara Jerome, Theron Alexis, Porto Alizee, Morera Pierre, Luporsi Paul, Jaussaud Nicolas, Gariboldi Vlad, Collart Frederic, Cuisset Thomas, Deharo Pierre
Département de Cardiologie, CHU Timone, 13005 Marseille, France.
Département de Chirurgie Cardiaque, CHU Timone, 13005 Marseille, France.
J Clin Med. 2022 Apr 1;11(7):1959. doi: 10.3390/jcm11071959.
Prosthesis−patient mismatch (PPM) is associated with worse outcomes following surgical aortic valve replacement (SAVR). PPM has been identified in a significant proportion of TAVR, particularly in patients with small aortic annuli. Our objective was to evaluate the hemodynamic performances of balloon-expandable (BE) (Sapiens 3TM) versus two different self-expandable (SE) (Evolut ProTM, Accurate NeoTM) TAVR devices in patients with small aortic annulus defined by a computed tomography aortic annulus area (AAA) between 330 and 440 mm2. We enrolled 131 consecutive patients corresponding to 76 Sapiens 3 23 mm (58.0%), 26 Evolut Pro (19.9%) and 29 Accurate Neo (22.1%). Mean age was 82.5 ± 7.06 years, 22.9% of patients were male and mean Euroscore was 4.0%. Mean AAA was 374 ± 27 mm2 for Sapiens 3, 383 ± 29 mm2 for Corevalve Evolut Pro and 389 ± 25 mm2 for Accurate Neo. BE devices were associated with significantly higher rates of PPM (39.5%) as compared to SE devices (15.4% for Corevalve Evolut Pro and 6.9% for Accurate Neo) (p < 0.0001). Paravalvular leaks ≥ 2/4 were more often observed in SE devices (15.4% for Corevalve Evolut Pro and 17.2% for Accurate Neo) than in BE devices (2.6%) (p = 0.007). In conclusion, SE TAVR devices did achieve better hemodynamic results despite higher rates of paravalvular leaks. Therefore, SE TAVI devices could be considered as first choice in small aortic anatomy.
人工瓣膜-患者不匹配（PPM）与外科主动脉瓣置换术（SAVR）后较差的预后相关。在相当比例的经导管主动脉瓣置换术（TAVR）中已发现PPM，尤其是在主动脉瓣环较小的患者中。我们的目的是评估在计算机断层扫描主动脉瓣环面积（AAA）在330至440 mm²之间定义的小主动脉瓣环患者中，球囊扩张式（BE）（Sapiens 3TM）与两种不同的自膨胀式（SE）（Evolut ProTM，Accurate NeoTM）TAVR装置的血流动力学性能。我们连续纳入了131例患者，其中76例使用Sapiens 3 23 mm（58.0%），26例使用Evolut Pro（19.9%），29例使用Accurate Neo（22.1%）。平均年龄为82.5±7.06岁，22.9%的患者为男性，平均欧洲心脏手术风险评估系统（Euroscore）评分为4.0%。Sapiens 3的平均AAA为374±27 mm²，Corevalve Evolut Pro为383±29 mm²，Accurate Neo为389±25 mm²。与SE装置（Corevalve Evolut Pro为15.4%，Accurate Neo为6.9%）相比，BE装置的PPM发生率显著更高（39.5%）（p<0.0001）。在SE装置（Corevalve Evolut Pro为15.4%，Accurate Neo为17.2%）中比在BE装置（2.6%）中更常观察到≥2/4级的瓣周漏（p = 0.007）。总之，尽管瓣周漏发生率较高，但SE TAVR装置确实取得了更好的血流动力学结果。因此，在主动脉瓣解剖结构较小的情况下，SE TAVI装置可被视为首选。
