Saito Shunsuke, Sairenchi Toshimi, Hirota Shotaro, Niitsuma Ken, Yokoyama Shohei, Kanno Yasuyuki, Kanazawa Yuta, Tezuka Masahiro, Takei Yusuke, Tsuchiya Go, Konishi Taisuke, Shibasaki Ikuko, Ogata Koji, Monta Osamu, Tsutsumi Yasushi, Fukuda Hirotsugu
Department of Cardiac and Vascular Surgery, Dokkyo Medical University, 880 Kitakobayashi, Mibu 321-0293, Japan.
Medical Science of Nursing, School of Nursing, Dokkyo Medical University, 880 Kitakobayashi, Mibu 321-0293, Japan.
J Cardiovasc Dev Dis. 2022 Oct 16;9(10):355. doi: 10.3390/jcdd9100355.
Background This study compared the clinical outcomes of transcatheter (TAVR) and surgical (SAVR) aortic valve replacements, focusing on postoperative valvular performance assessed by echocardiography. Method and Results A total of 425 patients who underwent TAVR (230 patients) or SAVR (195 patients) were included. Postoperative effective orifice area index (EOAI) was higher in the TAVR group (1.27 ± 0.35 cm2/m2) than in the SAVR group (1.06 ± 0.27 cm2/m2, p < 0.001), and patient−prosthesis mismatch (PPM) was more frequent in the SAVR group (22.6%) than in the TAVR group (8.7%, p < 0.001). Mild or greater paravalvular leakage (PVL) was more frequent in the TAVR group (21.3%) than in the SAVR group (0%, p < 0.001). Moreover, there was no difference in freedom from all-cause death, stroke, or rehospitalization between the groups. Patients with moderate or greater PPM (EOAI < 0.85 cm2/m2) had lower freedom from composite events than those without this PPM criterion (p = 0.008). Patients with mild or greater PVL also had lower freedom from composite events than those without this PVL criterion (p = 0.017). Conclusions Postoperative valvular performance of TAVR was superior to that of SAVR in terms of EOAI. This merit was counterbalanced by the significantly lower rates of PVL in patients who underwent SAVR. The overall clinical outcomes were similar between the study groups.
背景 本研究比较了经导管主动脉瓣置换术（TAVR）和外科主动脉瓣置换术（SAVR）的临床结局，重点关注通过超声心动图评估的术后瓣膜性能。方法与结果 共纳入425例行TAVR（230例患者）或SAVR（195例患者）的患者。TAVR组术后有效瓣口面积指数（EOAI）（1.27±0.35cm²/m²）高于SAVR组（1.06±0.27cm²/m²，p<0.001），且SAVR组患者-人工瓣膜不匹配（PPM）发生率（22.6%）高于TAVR组（8.7%，p<0.001）。TAVR组轻度及以上瓣周漏（PVL）发生率（21.3%）高于SAVR组（0%，p<0.001）。此外，两组间全因死亡、卒中或再住院的无事件生存率无差异。中度及以上PPM（EOAI<0.85cm²/m²）的患者复合事件无事件生存率低于无该PPM标准的患者（p=0.008）。轻度及以上PVL的患者复合事件无事件生存率也低于无该PVL标准的患者（p=0.017）。结论 就EOAI而言，TAVR的术后瓣膜性能优于SAVR。接受SAVR的患者PVL发生率显著较低抵消了这一优点。研究组间的总体临床结局相似。
