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低风险或中风险患者中Navitor经导管主动脉瓣的30天和1年结局

Thirty-Day And One-Year Outcomes Of Navitor Transcatheter Aortic Valve In Low- or Intermediate-Risk Patients.

作者信息

Worthley Stephen G, Giordano Arturo, Corcione Nicola, Nombela-Franco Luis, De Marco Federico, Walton Antony, Bedogni Francesco, Möllmann Helge, De Backer Ole, Leroux Lionel, Manoharan Ganesh, Tchétché Didier, Taramasso Maurizio, Li Lihua, Kuo Hai-Chien, Van Mieghem Nicolas M

机构信息

Department of Cardiology, Macquarie University Hospital, Macquarie Park, New South Wales, Australia.

Cardiovascular Interventional Operative Unit, Presidio Ospedaliero Pineta Grande, Castel Volturno, Caserta, Italy.

出版信息

JACC Cardiovasc Interv. 2025 Aug 21. doi: 10.1016/j.jcin.2025.08.021.

Abstract

BACKGROUND

The Navitor transcatheter aortic valve is a self-expanding, intra-annular valve indicated for patients with severe aortic stenosis (AS) at high or extreme surgical risk.

OBJECTIVES

To assess the safety and effectiveness of the Navitor valve in severe AS patients at low or intermediate surgical risk.

METHODS

VANTAGE is a prospective, single-arm, multicenter study. The primary effectiveness endpoint was moderate or greater paravalvular leakage (PVL) at 30 days; the primary safety endpoint was all-cause mortality or fatal stroke/stroke with disability at 12 months. Both endpoints were assessed against a performance goal (PG) when the sample size requirements were met. Clinical events and imaging assessments were evaluated by an independent committee and a core laboratory, respectively.

RESULTS

A total of 434 patients (203 low-risk, 231 intermediate-risk) underwent Navitor implantation between July 2021 and November 2024 across 36 sites in Europe, Australia, and Israel. The mean STS-PROM scores were 1.5% and 2.6% for the low- and intermediate-risk groups. Technical success was 97.0%, with no procedural mortality. At 30 days, no patients had moderate or greater PVL (0%), which was significantly below the PG of 6.6% (p<0.0001). In the first 262 patients with 12-month follow-up completed, the rate for all-cause mortality or fatal stroke/stroke with disability was 2.3%, also significantly below the PG of 11.3% (p<0.0001). Sustained hemodynamic performance (mean gradient 8.0 mmHg, effective orifice area 1.8 cm) was seen through 12 months.

CONCLUSION

Navitor demonstrated favorable safety and performance outcomes at 12 months, supporting its expansion to low- and intermediate-risk populations.

摘要

背景

Navitor经导管主动脉瓣是一种自膨胀式、瓣环内瓣膜,适用于手术风险高或极高的严重主动脉瓣狭窄(AS)患者。

目的

评估Navitor瓣膜在手术风险低或中等的严重AS患者中的安全性和有效性。

方法

VANTAGE是一项前瞻性、单臂、多中心研究。主要有效性终点是30天时中度或更严重的瓣周漏(PVL);主要安全性终点是12个月时全因死亡率或致命性卒中/致残性卒中。当满足样本量要求时,两个终点均根据性能目标(PG)进行评估。临床事件和影像评估分别由独立委员会和核心实验室进行评估。

结果

2021年7月至2024年11月期间,欧洲、澳大利亚和以色列的36个地点共有434例患者(203例低风险、231例中等风险)接受了Navitor植入。低风险和中等风险组的平均STS-PROM评分分别为1.5%和2.6%。技术成功率为97.0%,无手术死亡。30天时,无患者出现中度或更严重的PVL(0%),显著低于6.6%的PG(p<0.0001)。在完成12个月随访的前262例患者中,全因死亡率或致命性卒中/致残性卒中的发生率为2.3%,也显著低于11.3%的PG(p<0.0001)。在12个月内观察到持续的血流动力学性能(平均压差8.0 mmHg,有效瓣口面积1.8 cm)。

结论

Navitor在12个月时显示出良好的安全性和性能结果,支持其扩大到低风险和中等风险人群。

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