再次手术主动脉瓣置换术与经导管瓣中瓣植入术的血流动力学及临床结局对比
Hemodynamic and Clinical Outcomes in Redo-Surgical Aortic Valve Replacement vs. Transcatheter Valve-in-Valve.
作者信息
Hecht Sébastien, Zenses Anne-Sophie, Bernard Jérémy, Tastet Lionel, Côté Nancy, de Freitas Campos Guimarães Leonardo, Paradis Jean-Michel, Beaudoin Jonathan, O'Connor Kim, Bernier Mathieu, Dumont Eric, Kalavrouziotis Dimitri, Delarochellière Robert, Mohammadi Siamak, Clavel Marie-Annick, Rodés-Cabau Josep, Salaun Erwan, Pibarot Philippe
机构信息
Institut universitaire de cardiologie et de pneumologie de Québec/Québec Heart & Lung Institute, Universite Laval / Laval University, Québec City, Québec, Canada.
出版信息
Struct Heart. 2022 Oct 28;6(6):100106. doi: 10.1016/j.shj.2022.100106. eCollection 2022 Nov.
BACKGROUND
Transcatheter valve-in-valve replacement (ViV-TAVR) has emerged as an alternative to redo-surgical aortic valve replacement (Redo-SAVR) for the treatment of failed surgical aortic bioprostheses. However, the benefit of ViV-TAVR compared with Redo-SAVR remains debated with regard to short-term hemodynamic results and short- and long-term clinical outcomes.
OBJECTIVE
This study aimed to compare short-term hemodynamic performance and long-term clinical outcomes of ViV-TAVR vs. Redo-SAVR in patients treated for surgical aortic bioprosthetic valve failure.
METHODS
We retrospectively analyzed the data prospectively collected in 184 patients who underwent Redo-SAVR or ViV-TAVR. Transthoracic echocardiography was performed before and after the procedure and analyzed in an echocardiography core laboratory using the new Valve Academic Research Consortium-3 criteria. An inverse probability of treatment weighting was used to compare the outcomes between both procedures.
RESULTS
ViV-TAVR showed lower rate of intended hemodynamic performance (39.2% vs. 67.7%, < 0.001) at 30 days, which was essentially driven by a higher rate (56.2% vs. 28.8%, = 0.001) of high residual gradient (mean transvalvular gradient ≥20 mm Hg). Despite a trend for higher 30-day mortality in the Redo-SAVR vs. ViV-TAVR group (8.7% vs. 2.5%, odds ratio [95% CI]: 3.70 [0.77-17.6]; = 0.10), the long-term mortality was significantly lower (24.2% vs. 50.1% at 8 years; hazard ratio [95% CI]: 0.48 [0.26-0.91]; = 0.03) in the Redo-SAVR group. After inverse probability of treatment weighting analysis, Redo-SAVR remained significantly associated with reduced long-term mortality compared with ViV-TAVR (hazard ratio [95% CI]: 0.32 [0.22-0.46]; < 0.001).
CONCLUSIONS
ViV-TAVR was associated with a lower rate of intended hemodynamic performance and numerically lower mortality at 30 days but higher rates of long-term mortality compared with Redo-SAVR.
背景
经导管瓣中瓣置换术（ViV-TAVR）已成为再次行外科主动脉瓣置换术（Redo-SAVR）治疗外科主动脉生物瓣功能障碍的替代方法。然而，与Redo-SAVR相比，ViV-TAVR在短期血流动力学结果以及短期和长期临床结局方面的益处仍存在争议。
目的
本研究旨在比较ViV-TAVR与Redo-SAVR在接受外科主动脉生物瓣功能障碍治疗患者中的短期血流动力学表现和长期临床结局。
方法
我们回顾性分析了前瞻性收集的184例行Redo-SAVR或ViV-TAVR患者的数据。在手术前后进行经胸超声心动图检查，并在超声心动图核心实验室使用新的瓣膜学术研究联盟-3标准进行分析。采用治疗权重的逆概率来比较两种手术的结局。
结果
ViV-TAVR在30天时达到预期血流动力学表现的比例较低（39.2%对67.7%，P<0.001），这主要是由较高的高残余梯度发生率（平均跨瓣压差≥20 mmHg，56.2%对28.8%，P = 0.001）所致。尽管Redo-SAVR组30天死亡率有高于ViV-TAVR组的趋势（8.7%对2.5%，优势比[95%CI]：3.70[0.77-17.6]；P = 0.10），但Redo-SAVR组的长期死亡率显著较低（8年时为24.2%对50.1%；风险比[95%CI]：0.48[0.26-0.91]；P = 0.03）。经过治疗权重的逆概率分析后，与ViV-TAVR相比，Redo-SAVR仍与降低的长期死亡率显著相关（风险比[95%CI]：0.32[0.22-0.46]；P<0.001）。
结论
与Redo-SAVR相比，ViV-TAVR在30天时达到预期血流动力学表现的比例较低，30天死亡率在数值上较低，但长期死亡率较高。
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