Comparison of Transcatheter and Surgical Aortic Valve Replacement in Severe Aortic Stenosis

被引：204

作者：

Hahn, Rebecca T. ^{[1
,2
]}

Pibarot, Philippe ^{[3
]}

Stewart, William J. ^{[4
]}

Weissman, Neil J. ^{[5
]}

Gopalakrishnan, Deepika ^{[6
]}

Keane, Martin G. ^{[7
]}

Anwaruddin, Saif ^{[7
]}

Wang, Zuyue ^{[5
]}

Bilsker, Martin ^{[8
]}

Lindman, Brian R. ^{[9
]}

Herrmann, Howard C. ^{[7
]}

Kodali, Susheel K. ^{[1
,2
]}

Makkar, Raj ^{[10
]}

Thourani, Vinod H. ^{[11
]}

Svensson, Lars G. ^{[4
]}

Akin, Jodi J. ^{[12
]}

Anderson, William N. ^{[12
]}

Leon, Martin B. ^{[1
,2
]}

Douglas, Pamela S. ^{[13
]}

机构：

[1] Columbia Univ, Med Ctr, NYP Columbia Heart Valve Ctr, New York, NY 10032 USA

[2] New York Presbyterian Hosp, New York, NY USA

[3] Univ Laval, Dept Med, Quebec City, PQ G1K 7P4, Canada

[4] Cleveland Clin Fdn, Cleveland, OH 44195 USA

[5] Medstar Washington Hosp Ctr, Washington, DC USA

[6] Med City Dallas, Dallas, TX USA

[7] Hosp Univ Penn, Philadelphia, PA 19104 USA

[8] Univ Miami, Miami, FL USA

[9] Washington Univ, Sch Med, Dept Med, Div Cardiovasc, St Louis, MO 63110 USA

[10] Cedars Sinai Med Ctr, Los Angeles, CA 90048 USA

[11] Emory Univ, Sch Med, Atlanta, GA USA

[12] Edwards Lifesci, Irvine, CA USA

[13] Duke Univ, Med Ctr, Duke Clin Res Inst, Div Cardiovasc Med, Durham, NC USA

来源：

JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY | 2013年 / 61卷 / 25期

关键词：

aortic stenosis; echocardiography; surgical aortic valve replacement; transcatheter aortic valve replacement; PARAVALVULAR REGURGITATION; AMERICAN-SOCIETY; ECHOCARDIOGRAPHYS GUIDELINES; EUROPEAN-ASSOCIATION; STANDARDS COMMITTEE; IMPLANTATION; RECOMMENDATIONS; OUTCOMES; CONJUNCTION; PREVALENCE;

D O I：

10.1016/j.jacc.2013.02.087

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

Objectives This study sought to compare echocardiographic findings in patients with critical aortic stenosis following surgical aortic valve replacement (SAVR) or transcatheter aortic valve replacement (TAVR). Background The PARTNER (Placement of Aortic Transcatheter Valves) trial randomized patients 1:1 to SAVR or TAVR. Methods Echocardiograms were obtained at baseline, discharge, 30 days, 6 months, 1 year, and 2 years after the procedure and analyzed in a core laboratory. For the analysis of post-implantation variables, the first interpretable study (<= 6 months) was used. Results Both groups showed a decrease in aortic valve gradients and increase in effective orifice area (EOA) (p < 0.0001), which remained stable over 2years. Compared with SAVR, TAVR resulted in larger indexed EOA(p < 0.038), less prosthesis-patient mismatch (p = 0.019), and more total and paravalvular aortic regurgitation (p < 0.0001). Baseline echocardiographic univariate predictors of death were lower peak transaortic gradient in TAVR patients, and low left ventricular diastolic volume, low stroke volume, and greater severity of mitral regurgitation in SAVR patients. Post-implantation echocardiographic univariate predictors of death were: larger left ventricular diastolic volume, left ventricular systolic volume and EOA, decreased ejection fraction, and greater aortic regurgitation in TAVR patients; and smaller left ventricular systolic and diastolic volumes, low stroke volume, smaller EOA, and prosthesis-patient mismatch in SAVR patients. Conclusions Patients randomized to either SAVR or TAVR experience enduring, significant reductions in transaortic gradients and increase in EOA. Compared with SAVR, TAVR patients had higher indexed EOA, lower prosthesis-patient mismatch, and more aortic regurgitation. Univariate predictors of death for the TAVR and SAVR groups differed and might allow future refinement in patient selection. (C) 2013 by the American College of Cardiology Foundation

引用

页码：2514 / 2521

页数：8

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