Long-Term Valve Performance of TAVR and SAVR: A Report From the PARTNER I Trial

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• 作者：Melissa A. Daubert ; MD^a ; ^{melissa.daubert@duke.edu} ; Neil J. Weissman ; MD^b ; Rebecca T. Hahn ; MD^c ; Philippe Pibarot ; DVM ; PhD^d ; Rupa Parvataneni ; MS^e ; Michael J. Mack ; MD^f ; Lars G. Svensson ; MD ; PhD^g ; Deepika Gopal ; MD^f ; Samir Kapadia ; MD^g ; Robert J. Siegel ; MD^h ; Susheel K. Kodali ; MD^c ; Wilson Y. Szeto ; MDⁱ ; Raj Makkar ; MD^h ; Martin B. Leon ; MD^c ; Pamela S. Douglas ; MD^a
• 关键词：aortic stenosis ; surgical aortic valve replacement ; transcatheter aortic valve replacement
• 刊名：JACC: Cardiovascular Imaging
• 出版年：2017
• 出版时间：January 2017
• 年：2017
• 卷：10
• 期：1
• 页码：15-25
• 全文大小：658 K
• 卷排序：10

文摘

The aim of this study was to evaluate the long-term performance of transcatheter aortic valve replacement (TAVR) and surgical aortic valve replacement (SAVR) through longitudinal echocardiographic analysis.BackgroundThe long-term performance of the SAPIEN TAVR is not well-described. Therefore, we examined the hemodynamic and valvular profile of the SAPIEN TAVR over 5 years.MethodsAll patients receiving TAVR or SAVR with first post-implant (FPI) and 5-year echoes were analyzed for aortic valve (AV) peak velocity, AV mean gradient, AV area, peak left ventricular (LV) outflow tract and in-stent velocities, Doppler velocity index, aortic regurgitation (AR), LV mass index, stroke volume index, and cardiac index. The FPI and 5-year data were compared using a paired t test or McNemar’s analyses.ResultsThere were 86 TAVR and 48 SAVR patients with paired FPI and 5-year echocardiograms. Baseline characteristics were similar between groups. The AV area did not change significantly 5 years after TAVR (p = 0.35). The AV mean gradient also remained stable: 11.5 ± 5.4 mm Hg at FPI to 11.0 ± 6.3 mm Hg at 5 years (p = 0.41). In contrast, the peak AV and LV outflow tract velocities decreased (p = 0.03 and p = 0.008, respectively), as did in-stent velocity (p = 0.015). Correspondingly, the TAVR Doppler velocity index was unchanged (p = 0.07). Among TAVR patients, there was no change in total AR (p = 0.40), transvalvular AR (p = 0.37), or paravalvular AR (p = 0.26). Stroke volume index and cardiac index remained stable (p = 0.16 and p = 0.25, respectively). However, there was a significant regression of LV mass index (p < 0.0001). The longitudinal evaluation among SAVR patients revealed similar trends. There was a low rate of adverse events among TAVR and SAVR patients alive at 5 years.ConclusionsLongitudinal assessment of the PARTNER (THE PARTNER TRIAL: Placement of AoRTic TraNscathetER Valve Trial) I trial demonstrates that valve performance and cardiac hemodynamics are stable after implantation in both SAPIEN TAVR and SAVR in patients alive at 5 years. (THE PARTNER TRIAL: Placement of AoRTic TraNscathetER Valve Trial [PARTNER]; NCT00530894)