Effects of transcatheter aortic valve replacement in patients with severe aortic valve stenosis
10.3760/cma.j.issn.0253-3758.2019.07.004
- VernacularTitle: 经导管主动脉瓣置换术治疗重度主动脉瓣狭窄的效果
- Author:
Qinchun JIN
1
;
Wenzhi PAN
;
Shasha CHEN
;
Xiaochun ZHANG
;
Lei ZHANG
;
Daxin ZHOU
Author Information
1. Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai 200032, China
- Publication Type:Journal Article
- Keywords:
Aortic valve stenosis;
Treatment outcome;
Transcatheter aortic valve replacement
- From:
Chinese Journal of Cardiology
2019;47(7):528-533
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To investigate the effects of transcatheter aortic valve replacement (TAVR) in patients with severe aortic valve stenosis.
Methods:The clinical data of 130 patients with severe aortic valve stenosis, who underwent TAVR in our hospital with self-expanding valve between January 1,2010 and October 30, 2016, were analyzed retrospectively. The patients were divided into calcific aortic valve stenosis (CAS) group (112 cases) and non-calcific aortic valve stenosis (NCAS) group (18 cases) according to 3D volume-rendering reconstruction under multiple detector computed tomography before TAVR. The baseline clinical features, imageology results, procedural details, and clinical prognosis were compared between the 2 groups.
Results:(1) Compared with CAS group, the patients in NCAS group were younger, had higher proportion of rheumatic heart disease, and less proportion of bicuspid aortic valve morphology (P<0.01 or 0.05). Except for minimum value of sinotubular junction (P=0.017), there were no significant differences in multiple detector computed tomography measurements of aortic valve annulus and aortic root structure between the 2 groups (all P>0.05). (2) Compared with CAS group, the proportions of valve release under rapid pacing and oversized valve release were larger than pre-procedural evaluation, and the proportion of post-dilation was lower in NCAS group (P<0.01 or 0.05). (3) Post-procedural transthoracic echocardiography revealed that left ventricular ejection fraction was higher than baseline level in CAS group (P<0.001), while which was similar in NCAS group (P=0.552). Compared with before TAVR, mean pressure gradient and maximum transvalvular velocity were significantly reduced, aortic valve orifice area was significantly increased, and proportion of moderate to severe aortic regurgitation was significantly reduced after the procedure in both groups (all P<0.01). There were no significant differences in left ventricular ejection fraction, mean pressure gradient, maximum transvalvular velocity, aortic valve orifice area, and proportion of moderate to severe aortic regurgitation after TAVR between the 2 groups (all P>0.05). (4) There were no significant differences in successful rate of device placement and cardiovascular related death within 30 days after TAVR between the 2 groups (105/112 vs. 17/18, P=0.909; 3/112 vs. 1/18, P=0.453, respectively).
Conclusion:TAVR is safe and effective for patients with severe aortic valve stenosis.
