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使用自膨胀装置进行经导管主动脉瓣植入术后的十年耐久性、血流动力学性能及临床结果

Ten-year Durability, Hemodynamic Performance, and Clinical Outcomes after Transcatheter Aortic Valve Implantation Using a Self-expanding Device.

作者信息

Elbasha Karim, Kaur Jatinderjit, Abdelghani Mohammad, Landt Martin, Alotaibi Sultan, Abdelaziz Ahmed, Abdel-Wahab Mohamed, Toelg Ralph, Geist Volker, Richardt Gert, Allali Abdelhakim

机构信息

Cardiology Department, Heart Centre Segeberger Kliniken GmbH, Am Kurpak 1, 23795, Bad Segeberg, Germany.

Cardiology Department, Zagazig University, Sharkia, Egypt.

出版信息

Cardiol Ther. 2024 Sep;13(3):529-540. doi: 10.1007/s40119-024-00369-2. Epub 2024 May 12.


DOI:10.1007/s40119-024-00369-2
PMID:38734999
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11333656/
Abstract

INTRODUCTION: The expansion of transcatheter aortic valve implantation (TAVI) to low-risk and younger patients has increased the relevance of the long-term durability of transcatheter heart valves (THV). The present study aims to assess the 10-year durability, hemodynamic performance, and clinical outcomes after TAVI using the CoreValve system. METHODS: An analysis from a prospective registry with predefined clinical and echocardiographic follow-up included 302 patients who underwent TAVI with the CoreValve system between 2007 and 2015. Bioprosthetic valve failure (BVF) was defined as any bioprosthetic valve dysfunction-related death, re-intervention, or severe hemodynamic valve deterioration. RESULTS: At the time of TAVI, the mean age was 80.41 ± 7.01 years, and the Society of Thoracic Surgeons (STS) score was 6.13 ± 5.23%. At latest follow-up (median [IQR]: 5 [2-7] years), cumulative all-cause mortality rates at 3, 5, 7, and 10 years was 23.7%, 40%, 65.8%, and 89.8%, respectively. Mean aortic valve area and transvalvular gradient post-TAVI and at 5, 7, and 10 years were 1.94, 1.87, 1.69, and 1.98 cm (p = 0.236) and 8.3, 9.0, 8.2, and 10.1 mmHg (p = 0.796), respectively. Overall, 11 patients had BVF, of whom six had structural valve deterioration (SVD). The 10-year actual and actuarial freedom from BVF was 96.1% and 78.8%, and from SVD was 97.9% and 80.9%, respectively. Three patients developed significant non-SVD due to severe paravalvular leakage, and two patients were diagnosed with infective endocarditis. CONCLUSION: Using an early-generation self-expanding bioprosthesis, we documented durable hemodynamic performance and low rates of BVF and SVD up to 10 years after TAVI.

摘要

引言:经导管主动脉瓣植入术(TAVI)向低风险和年轻患者的扩展增加了经导管心脏瓣膜(THV)长期耐久性的相关性。本研究旨在评估使用CoreValve系统进行TAVI术后10年的耐久性、血流动力学性能和临床结局。 方法:一项来自前瞻性注册研究的分析,该研究有预定义的临床和超声心动图随访,纳入了2007年至2015年间302例接受CoreValve系统TAVI的患者。生物瓣膜失效(BVF)定义为任何与生物瓣膜功能障碍相关的死亡、再次干预或严重的血流动力学瓣膜恶化。 结果:TAVI时,平均年龄为80.41±7.01岁,胸外科医师协会(STS)评分为6.13±5.23%。在最新随访时(中位数[四分位间距]:5[2 - 7]年),3年、5年、7年和10年的累积全因死亡率分别为23.7%、40%、65.8%和89.8%。TAVI术后及5年、7年和10年时的平均主动脉瓣面积和跨瓣压差分别为1.94、1.87、1.69和1.98 cm²(p = 0.236)以及8.3、9.0、8.2和10.1 mmHg(p = 0.796)。总体而言,11例患者发生BVF,其中6例有结构性瓣膜恶化(SVD)。10年实际和精算无BVF率分别为96.1%和78.8%,无SVD率分别为97.9%和80.9%。3例患者因严重瓣周漏出现显著非SVD,2例患者被诊断为感染性心内膜炎。 结论:使用早期一代的自膨胀生物瓣膜,我们记录了TAVI术后长达10年的持久血流动力学性能以及低BVF和SVD发生率。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/f353/11333656/8a3492cb27f5/40119_2024_369_Fig2_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/f353/11333656/3987334743a8/40119_2024_369_Fig1_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/f353/11333656/8a3492cb27f5/40119_2024_369_Fig2_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/f353/11333656/3987334743a8/40119_2024_369_Fig1_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/f353/11333656/8a3492cb27f5/40119_2024_369_Fig2_HTML.jpg

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引用本文的文献

[1]
Current Management and Therapy of Severe Aortic Stenosis and Future Perspective.

J Atheroscler Thromb. 2024-10-1

本文引用的文献

[1]
Transcatheter or surgical aortic valve implantation: 10-year outcomes of the NOTION trial.

Eur Heart J. 2024-4-1

[2]
3-Year Outcomes After Transcatheter or Surgical Aortic Valve Replacement in Low-Risk Patients With Aortic Stenosis.

J Am Coll Cardiol. 2023-5-2

[3]
2021 ESC/EACTS Guidelines for the management of valvular heart disease.

Eur J Cardiothorac Surg. 2021-10-22

[4]
Valve Academic Research Consortium 3: updated endpoint definitions for aortic valve clinical research.

Eur Heart J. 2021-5-14

[5]
Ten year follow-up of high-risk patients treated during the early experience with transcatheter aortic valve replacement.

Catheter Cardiovasc Interv. 2021-2-15

[6]
Transcatheter aortic valve replacement in low risk patients: a review of PARTNER 3 and Evolut low risk trials.

Cardiovasc Diagn Ther. 2020-2

[7]
Transcatheter Aortic-Valve Replacement with a Balloon-Expandable Valve in Low-Risk Patients.

N Engl J Med. 2019-3-16

[8]
Long-Term Durability of Transcatheter Aortic Valve Prostheses.

J Am Coll Cardiol. 2019-2-12

[9]
Five-Year Clinical Outcome and Valve Durability After Transcatheter Aortic Valve Replacement in High-Risk Patients.

Circulation. 2018-12-4

[10]
Standardized Definition of Structural Valve Degeneration for Surgical and Transcatheter Bioprosthetic Aortic Valves.

Circulation. 2018-1-23

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