主动脉瓣狭窄的心脏反向重构与手术和经导管主动脉瓣置换术的比较

Koichi Inoue MD , Koichi Maeda MD, PhD , Kyongsun Pak PhD , Kazuo Shimamura MD, PhD , Arudo Hiraoka MD, PhD , Hidenori Yoshitaka MD, PhD , Katsukiyo Kitabayashi MD, PhD , Haruhiko Kondoh MD, PhD , Yukitoshi Sirakawa MD, PhD , Shigeru Miyagawa MD, PhD
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引用次数: 0

摘要

背景:主动脉瓣置换术(SAVR)或经导管主动脉瓣置换术(TAVR)后左心室反向重构与主动脉瓣狭窄患者的积极临床结果相关。然而,SAVR和TAVR在左心室肿块消退中的作用尚不清楚。本研究比较了SAVR和TAVR的左心室质量变化。方法纳入1939例主动脉瓣狭窄患者,分别行单纯SAVR或TAVR,进行1:1倾向匹配(247对)。主要观察指标是SAVR和TAVR之间左心室质量的时间变化。通过超声心动图评估和计算随访1年的左心室质量回归。结果在一个匹配的队列中,与TAVR相比,SAVR在30天(SAVR vs TAVR:平均值,- 11.2% [95% CI, - 13.4%至- 8.9%]比平均值,- 2.6% [95% CI, - 5.0%至- 0.4%],P < 01)和1年时(SAVR vs TAVR:平均值- 23.8% [95% CI, - 26.0%至- 21.6%]比- 13.8% [95% CI, - 16.6%至- 11.0%],P < 01)表现出更好的左心室质量回归。在多变量分析中,基线左室质量指数(优势比,1.04;95% CI, 1.03-1.05; P < 0.01)、SAVR选择(优势比,2.54;95% CI, 1.46-4.43; P < 0.01)和轻度或重度瓣旁漏(优势比,0.61;95% CI, 0.44-0.84; P < 0.01)与左室质量回归相关。结论在匹配的队列中,savr比TAVR表现出更好的左心室质量退化。考虑到患者的终身管理,选择最佳瓣膜是至关重要的。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Comparing Cardiac Reverse Remodeling in Aortic Stenosis With Surgical and Transcatheter Aortic Valve Replacement

Background

Left ventricular reverse remodeling, which is synonymous left ventricular mass regression, after surgical aortic valve replacement (SAVR) or transcatheter aortic valve replacement (TAVR) is associated with positive clinical outcomes in patients with aortic stenosis. However, the roles of SAVR and TAVR in left ventricular mass regression remain unclear. This study compared the left ventricular mass change between SAVR and TAVR.

Methods

Included were 1939 patients with aortic stenosis who underwent isolated SAVR or TAVR, and 1:1 propensity matching was performed (247 pairs). The primary outcome was the time course change of left ventricular mass between SAVR and TAVR. Left ventricular mass regression was evaluated and calculated up to 1 year of follow-up by echocardiography.

Results

In a matched cohort, SAVR demonstrated better left ventricular mass regression compared with TAVR at 30 days (SAVR vs TAVR: mean, −11.2% [95% CI, −13.4% to −8.9%] vs mean, −2.6% [95% CI, −5.0% to −0.4%], P < .01) and at 1 year (SAVR vs TAVR: mean −23.8% [95% CI, − 26.0% to −21.6%) vs −13.8% [95% CI, −16.6% to −11.0%], P < .01). In multivariable analysis, baseline left ventricular mass index (odds ratio, 1.04; 95% CI, 1.03-1.05; P < .01), SAVR choice (odds ratio, 2.54; 95% CI, 1.46-4.43; P < .01), and paravalvular leakage mild or more (odds ratio, 0.61; 95% CI, 0.44-0.84; P < .01) were associated with left ventricular mass regression.

Conclusions

SAVR demonstrated better left ventricular mass regression than TAVR in a matched cohort. Considering the lifetime management of the patients, selecting the optimal valve is crucial.
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