Transcatheter Aortic Valve Implantation in Patients With Low-Flow, Low-Gradient Aortic Stenosis

被引：75

作者：

Lauten, Alexander ^{[1
]}

Zahn, Ralf ^{[2
]}

Horack, Martin ^{[3
]}

Sievert, Horst ^{[4
]}

Linke, Axel ^{[5
]}

Ferrari, Markus ^{[1
]}

Harnath, Axel ^{[6
]}

Grube, Eberhard ^{[7
]}

Gerckens, Ulrich ^{[8
]}

Kuck, Karl-Heinz ^{[9
]}

Sack, Stefan ^{[10
]}

Senges, Jochen ^{[3
]}

Figulla, Hans R. ^{[1
]}

机构：

[1] Univ Heart Ctr Jena, Dept Internal Med 1, D-07747 Jena, Germany

[2] Herzzentrum, Dept Cardiol, Ludwigshafen, Germany

[3] Inst Herzinfarktforsch, Ludwigshafen, Germany

[4] Cardiovasc Ctr Frankfurt, Frankfurt, Germany

[5] Herzzentrum Leipzig, Dept Cardiol, Leipzig, Germany

[6] Sana Herzzentrum, Dept Cardiol, Cottbus, Germany

[7] Univ Klin Bonn, Med Klin 2, Bonn, Germany

[8] Gemeinschaftskrankenhaus Bonn, Dept Cardiol, Bonn, Germany

[9] Hanseat Heart Ctr Hamburg, Asklepios Klin St Georg, Dept Cardiol, Hamburg, Germany

[10] Klin Muenchen Schwabing, Dept Cardiol, Munich, Germany

来源：

JACC-CARDIOVASCULAR INTERVENTIONS | 2012年 / 5卷 / 05期

关键词：

aortic stenosis; low-flow; low-gradient; transcatheter aortic valve replacement; LEFT-VENTRICULAR DYSFUNCTION; TRANSVALVULAR PRESSURE-GRADIENTS; RISK STRATIFICATION; REPLACEMENT; ECHOCARDIOGRAPHY; MULTICENTER; PREDICTORS; DISEASE;

D O I：

10.1016/j.jcin.2012.04.001

中图分类号：

R5 [内科学];

学科分类号：

100201 [内科学];

摘要：

Objectives The purpose of this study was to evaluate the efficacy and outcome of transcatheter aortic valve implantation (TAVI) in patients with low-flow, low-gradient aortic stenosis (LG-AS). Background Patients with LG-AS have a poor prognosis with medical treatment and a high risk for surgical aortic valve replacement. Methods Between January 2009 and June 2010, a total of 1,302 patients underwent TAVI for severe AS and were prospectively included in the multicenter German TAVI registry. Results LG-AS was present in 149 patients (11.4%; mean age: 80.2 +/- 6.3 years). In this subgroup, the EuroSCORE was significantly higher (26.8 +/- 16.6 vs. 20.0 +/- 13.3; p < 0.0001) compared with patients with high-gradient AS (HG-AS). The procedural success rate (LG-AS: 95.3% vs. HG-AS: 97.5%; p = 0.13) and the rate of TAVI-associated complications were comparable in both groups (new pacemaker: 27.0% vs. 28.1%; p = 0.76; cerebrovascular events: 3.4% vs. 3.1%, p = 0.83). However, post-operative low-output syndrome occurred more frequently in the LG-AS-group (LG-AS: 14.9% vs. HG-AS: 5.7%, p < 0.0001), and mortality at 30 days and 1 year was significantly higher in this subgroup (LG-AS: 12.8% and 36.9% vs. HG-AS: 7.4% and 18.1%; p < 0.001 and p < 0.0001, respectively). Post-operative New York Heart Association functional class improved, and self-assessed quality of life increased significantly, demonstrating a substantial benefit in the LG-AS group at 30 days and 1 year after TAVI. Conclusions In high-risk patients with LG-AS, TAVI is associated with a significantly higher mortality at 30 days and at 1 year. However, long-term survivors benefit from TAVI with functional improvement and a significantly increased quality of life. Therefore, in view of the poor prognosis with medical treatment, TAVI should be considered an option in high-risk patients with LG-AS. (J Am Coll Cardiol Intv 2012;5:552-9) (C) 2012 by the American College of Cardiology Foundation

引用

页码：552 / 559

页数：8

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