Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA.
Department of Cardiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.
Open Heart. 2023 May;10(1). doi: 10.1136/openhrt-2023-002297.
To evaluate whether transcatheter or surgical aortic valve replacement (TAVR or SAVR) affects clinical and haemodynamic outcomes in symptomatic patients with moderately-severe aortic stenosis (AS).
Echocardiographic evidence of severe AS for enrolment in the Evolut Low Risk trial was based on site-reported measurements. For this post hoc analysis, core laboratory measurements identified patients with symptomatic moderately-severe AS (1.0<aortic valve area (AVA)<1.5 cm, 3.0<peak velocity<4.0 m/s and 20≤mean gradient (MG) <40 mm Hg). Clinical outcomes were reported through 2 years.
Moderately-severe AS was identified in 113 out of 1414 patients (8%). Baseline AVA was 1.1±0.1 cm, peak velocity 3.7±0.2 m/s, MG 32.7±4.8 mm Hg and aortic valve calcium volume 588 (364, 815) mm. Valve haemodynamics improved following TAVR (AVA 2.5±0.7 cm, peak velocity 1.9±0.5 m/s and MG 8.4±4.8 mm Hg; p<0.001 for all) and SAVR (AVA 2.0±0.6 cm, peak velocity 2.1±0.4 m/s and MG 10.0±3.4 mm Hg; p<0.001 for all). At 24 months, the rates of death or disabling stroke were similar (TAVR 7.7% vs SAVR 6.5%; p=0.82). Kansas City Cardiomyopathy Questionnaire overall summary score assessing quality of life improved from baseline to 30 days after TAVR (67.0±20.6 to 89.3±13.4; p<0.001) and SAVR (67.5±19.6 to 78.3±22.3; p=0.001).
In symptomatic patients with moderately-severe AS, AVR appears to be beneficial. Determination of the clinical and haemodynamic profile of patients who can benefit from earlier isolated AVR needs further investigation in randomised clinical trials.
评估经导管主动脉瓣置换术（TAVR）或外科主动脉瓣置换术（SAVR）对有症状的中度严重主动脉瓣狭窄（AS）患者的临床和血液动力学结果的影响。
Evolut 低危试验中纳入的严重 AS 的超声心动图证据基于站点报告的测量值。对于这项事后分析，核心实验室的测量确定了有症状的中度严重 AS 患者（1.0<aortic valve area (AVA)<1.5 cm，3.0<peak velocity<4.0 m/s 和 20≤mean gradient (MG) <40 mm Hg）。通过 2 年报告临床结果。
在 1414 名患者中有 113 名（8%）被诊断为中度严重 AS。基线 AVA 为 1.1±0.1 cm，峰值速度为 3.7±0.2 m/s，MG 为 32.7±4.8 mm Hg，主动脉瓣钙体积为 588（364，815）mm。TAVR（AVA 2.5±0.7 cm，峰值速度 1.9±0.5 m/s 和 MG 8.4±4.8 mm Hg；所有 p<0.001）和 SAVR（AVA 2.0±0.6 cm，峰值速度 2.1±0.4 m/s 和 MG 10.0±3.4 mm Hg；所有 p<0.001）后瓣膜血液动力学得到改善。24 个月时，死亡或致残性卒中的发生率相似（TAVR 为 7.7%，SAVR 为 6.5%；p=0.82）。经 TAVR（67.0±20.6 至 89.3±13.4；p<0.001）和 SAVR（67.5±19.6 至 78.3±22.3；p=0.001）后，使用堪萨斯城心肌病问卷整体综合评分评估生活质量从基线提高。
在有症状的中度严重 AS 患者中，AVR 似乎是有益的。需要进一步在随机临床试验中确定能从早期孤立性 AVR 中获益的患者的临床和血液动力学特征。
