Division of Cardiovascular Medicine, University of Louisville School of Medicine, Louisville, Kentucky.
Beth Israel Deaconess Medical Center and Harvard School of Medicine, Boston, Massachusetts.
Am J Cardiol. 2023 Dec 1;208:37-43. doi: 10.1016/j.amjcard.2023.08.140. Epub 2023 Oct 7.
Optimal timing for aortic valve replacement in symptomatic patients with less than severe aortic stenosis (AS) is not well defined. There is limited information on the benefit of valve replacement in these patients. Symptomatic patients with less than severe AS, defined as a mean aortic gradient ≥20 and <40 mm Hg, peak aortic velocity >3 and <4 m/s, and aortic valve area >1.0 and <1.5 cm, enrolled in the Society for Thoracic Surgery/American College of Cardiology Transcatheter Valve Therapy Registry and who underwent attempted supra-annular, self-expanding transcatheter aortic valve replacement (TAVR) were reviewed. Site-reported valve hemodynamics, clinical events, and quality of life metrics were analyzed at 30 days and 1 year after the procedure. A total of 1,067 patients with attempted TAVR (mean age 78.4 ± 8.4 years; Society for Thoracic Surgery score 4.7 ± 3.4%) were found to have symptoms but less than severe AS. From baseline to postprocedure, mean gradient decreased (29.9 ± 4.9 vs 8.4 ± 4.8 mm Hg, p <0.001), and aortic valve area increased (1.2 ± 0.1 vs 2.2 ± 0.7 cm, p <0.001). Clinical events included 30-day and 1-year all-cause mortality (1.5% and 9.6%), stroke (2.2% and 3.3%), and new pacemaker implantation (18.1% and 20.9%). There were statistically significant improvements in the New York Heart Association functional class and Kansas City Cardiomyopathy Questionnaire at 30 days and 1 year. In conclusion, patients with symptomatic but less than severe AS who underwent supra-annular, self-expanding TAVR experienced improved valve hemodynamics and quality of life measures 1 year after the procedure. Randomized studies of TAVR versus a control arm in symptomatic patients with less than severe AS are ongoing.
在有症状但主动脉瓣狭窄（AS）程度较轻的患者中，主动脉瓣置换的最佳时机尚未明确。目前，关于这些患者行瓣膜置换术的获益信息有限。本研究回顾性分析了登记于胸外科医师学会/美国心脏病学会经导管瓣膜治疗注册研究（STS/ACC TVT Registry）、接受瓣环上自膨式经导管主动脉瓣置换术（TAVR）治疗且有症状但 AS 程度较轻（平均主动脉瓣跨瓣压差≥20mmHg 且<40mmHg、峰值主动脉瓣流速>3m/s 且<4m/s、主动脉瓣面积>1.0cm² 且<1.5cm²）的患者的瓣膜血流动力学、临床结局和生活质量指标，评估术后 30d 和 1 年时的资料。共纳入 1067 例接受 TAVR 治疗的患者（平均年龄 78.4±8.4 岁；STS 评分 4.7±3.4%），这些患者均有症状但 AS 程度较轻。与基线时相比，术后平均跨瓣压差降低（29.9±4.9mmHg 比 8.4±4.8mmHg，p<0.001），主动脉瓣面积增加（1.2±0.1cm² 比 2.2±0.7cm²，p<0.001）。临床结局包括 30d 和 1 年全因死亡率（1.5%比 9.6%）、卒中和新植入起搏器比例（2.2%比 3.3%）。术后 30d 和 1 年时，纽约心脏病协会心功能分级和堪萨斯城心肌病问卷评分均有显著改善。综上，行瓣环上自膨式 TAVR 治疗的有症状但 AS 程度较轻的患者，术后 1 年时瓣膜血流动力学和生活质量指标均得到改善。目前正在进行 TAVR 与对照组治疗有症状且 AS 程度较轻患者的随机对照研究。
