Yamashita Yoshiyuki, Baudo Massimo, Sicouri Serge, Rodriguez Roberto, Gnall Eric M, Coady Paul M, Goldman Scott M, Gray William A, Ramlawi Basel
Department of Cardiothoracic Surgery, Lankenau Heart Institute, Main Line Health Wynnewood, Pennsylvania, USA.
Department of Cardiothoracic Surgery Research, Lankenau Institute for Medical Research, Wynnewood, Pennsylvania, USA.
Anatol J Cardiol. 2025 May 29;29(9):496-502. doi: 10.14744/AnatolJCardiol.2025.5157.
To compare the clinical outcomes of transcatheter aortic valve replace-ment (TAVR) for severe aortic stenosis (AS) in patients with different flow-gradient and left ventricular ejection fraction (EF) profiles.
Patients with severe AS who underwent TAVR with newer generation valves (Sapien3/3 Ultra, Evolut Pro/Pro+/FX) were retrospectively analyzed. Patients were divided into 5 groups: normal-flow high-gradient (NF-HG) AS (stroke volume index ≥ 35 mL/m2 and mean pressure gradient ≥ 40 mm Hg), low-flow high-gradient (LF-HG) with preserved EF (pEF, ≥ 50%), LF-HG with reduced EF (rEF), low-flow low-gradient (LF-LG) with pEF, and LF-LG with rEF.
A total of 846 patients were included in this study (NF-HG, n = 458; LF-HG with pEF, n = 142; LF-HG with rEF, n = 50; LF-LG with pEF, n = 113; LF-LG with rEF, n = 83). For the entire cohort, the median age was 82 years, and the periprocedural mortality rate was 2.1% with the highest rate in the LF-LG with rEF AS (7.2%). The 1-year and 5-year mortality rates were 13% and 51%, respectively. Multivariable Cox regression analysis showed higher all-cause mortality in the LF-HG with pEF (hazard ratio 1.42 [95% CI: 1.02-1.98]), LF-LG with pEF (1.84 [1.32-2.55]), and LF-LG with rEF (1.78 [1.22-2.61]) groups compared with the NF-HG group. Cardiovascular death rates were significantly higher in the LF-LG groups, but not in the LF-HG groups.
In addition to both LF-LG with pEF and rEF AS, LF-HG with pEF AS had a higher all-cause mortality rate after TAVR compared to NF-HG AS.
比较经导管主动脉瓣置换术（TAVR）治疗不同血流梯度和左心室射血分数（EF）的严重主动脉瓣狭窄（AS）患者的临床结局。
回顾性分析接受新一代瓣膜（Sapien3/3 Ultra、Evolut Pro/Pro+/FX）TAVR治疗的严重AS患者。患者分为5组：正常血流高梯度（NF-HG）AS（每搏量指数≥35 mL/m2且平均压力梯度≥40 mmHg）、左室射血分数保留（pEF，≥50%）的低血流高梯度（LF-HG）、左室射血分数降低（rEF）的LF-HG、pEF的低血流低梯度（LF-LG）和rEF的LF-LG。
本研究共纳入846例患者（NF-HG组458例；pEF的LF-HG组142例；rEF的LF-HG组50例；pEF的LF-LG组113例；rEF的LF-LG组83例）。整个队列的中位年龄为82岁，围手术期死亡率为2.1%，rEF的LF-LG AS组死亡率最高（7.2%）。1年和5年死亡率分别为13%和51%。多变量Cox回归分析显示，与NF-HG组相比，pEF的LF-HG组（风险比1.42[95%CI：1.02-1.98]）、pEF的LF-LG组（1.84[1.32-2.55]）和rEF的LF-LG组（1.78[1.22-2.61]）的全因死亡率更高。LF-LG组的心血管死亡率显著更高，但LF-HG组并非如此。
除了pEF和rEF的LF-LG AS外，与NF-HG AS相比，pEF的LF-HG AS在TAVR后全因死亡率更高。
