Echocardiographic Results of Transcatheter Versus Surgical Aortic Valve Replacement in Low-Risk Patients

作者：Philippe Pîbarot, Erwan Salaün, Abdellaziz Dahou, Eleonora Avenatti, Ezéquiel Guzzetti, Mohamed‐Salah Annabi, Oumhani Toubal, Mathieu Bernier, Jonathan Beaudoin, Géraldine Ong, Julien Ternacle, Laura Krapf, Vinod H. Thourani, Raj Makkar, Susheel Kodali, Mark J. Russo, Samir Kapadia, S. Chris Malaisrie, David J. Cohen, Jonathon Leipsic, Philipp Blanke, Mathew Williams, James M. McCabe, David L. Brown, Vasilis Babaliaros, Scott Goldman, Wilson Y. Szeto, Philippe Généreux, Ashish Pershad, Maria Alu, Ke Xu, Erin Rogers, John G. Webb, Craig R. Smith, Michael J. Mack, Martin B. Leon, Rebecca T. Hahn, For the PARTNER 3 Investigators · 发表于：Circulation · 年份：2020 · DOI：10.1161/circulationaha.119.044574 · 被引用次数：145 · 研究领域：Cardiac Valve Diseases and Treatments、Infective Endocarditis Diagnosis and Management、Cardiac pacing and defibrillation studies

Background: This study aimed to compare echocardiographic findings in low-risk patients with severe aortic stenosis after surgical aortic valve replacement (SAVR) or transcatheter aortic valve replacement (TAVR). Methods: The PARTNER 3 trial (Placement of Aortic Transcatheter Valves) randomized 1000 patients with severe aortic stenosis and low surgical risk to undergo either transfemoral TAVR with the balloon-expandable SAPIEN 3 valve or SAVR. Transthoracic echocardiograms obtained at baseline and at 30 days and 1 year after the procedure were analyzed by a consortium of 2 echocardiography core laboratories. Results: The percentage of moderate or severe aortic regurgitation (AR) was low and not statistically different between the TAVR and SAVR groups at 30 days (0.8% versus 0.2%; P =0.38). Mild AR was more frequent after TAVR than SAVR at 30 days (28.8% versus 4.2%; P <0.001). At 1 year, mean transvalvular gradient (13.7±5.6 versus 11.6±5.0 mm Hg; P =0.12) and aortic valve area (1.72±0.37 versus 1.76±0.42 cm 2 ; P =0.12) were similar in TAVR and SAVR. The percentage of severe prosthesis–patient mismatch at 30 days was low and similar between TAVR and SAVR (4.6 versus 6.3%; P =0.30). Valvulo-arterial impedance (Z va ), which reflects total left ventricular hemodynamic burden, was lower with TAVR than SAVR at 1 year (3.7±0.8 versus 3.9±0.9 mm Hg/mL/m 2 ; P <0.001). Tricuspid annulus plane systolic excursion decreased and the percentage of moderate or severe tricuspid regurgitat...