- 作者：Alexander Lauten ; MD?/sup> ; alexander.lauten@med.uni-jena.de ; Ralf Zahn ; MD&dagger ; ; Martin Horack ; MD&Dagger ; ; Horst Sievert ; MD§ ; ; Axel Linke ; MD?/sup> ; Markus Ferrari ; MD?/sup> ; Axel Harnath ; MD¶ ; ; Eberhard Grube ; MD# ; Ulrich Gerckens ; MD?? ; Karl-Heinz Kuck ; MD&dagger ; &dagger ; ; Stefan Sack ; MD&Dagger ; &Dagger ; ; Jochen Senges ; MD&Dagger ; ; Hans R. Figulla ; MD?/sup> ; German Transcatheter Aortic Valve Interventions Registry Investigators
- 关键词：aortic stenosis ; low-flow ; low-gradient ; transcatheter aortic valve replacement
- 刊名：JACC: Cardiovascular Interventions
- 出版年：2012
- 出版时间：May, 2012
- 年：2012
- 卷：5
- 期：5
- 页码：552-559
- 全文大小：578 K
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 ¡À 6.3 years). In this subgroup, the EuroSCORE was significantly higher (26.8 ¡À 16.6 vs. 20.0 ¡À 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.