Hemodynamic and Clinical Impact of Prosthesis¨CPatient Mismatch After Transcatheter Aortic Valve Implantation

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• 作者：See Hooi  ; Ewe MBBS^?/sup> ;   ; ^&dagger ; ; Manuela  ; Muratori MD^&Dagger ; ; Victoria  ; Delgado MD ; PhD^?/sup> ; Mauro  ; Pepi MD^&Dagger ; ; Gloria  ; Tamborini MD^&Dagger ; ; Laura  ; Fusini MS^§ ; ; Robert J.M.  ; Klautz MD ; PhD^?/sup> ; Paola  ; Gripari MD^&Dagger ; ; Jeroen J.  ; Bax MD ; PhD^?/sup> ; Melissa  ; Fusari MD^&Dagger ; ; Martin J.  ; Schalij MD ; PhD^?/sup> ; Nina Ajmone  ; Marsan MD^?/sup> ;   ; ^?/sup> ;   ; ^{n.ajmone@lumc.nl}
• 关键词：aortic valve ; echocardiography ; heart valve prosthesis ; hemodynamics ; transcatheter aortic valve implantation
• 刊名：Journal of the American College of Cardiology
• 出版年：2011
• 出版时间：25 October 2011
• 年：2011
• 卷：58
• 期：18
• 页码：1910-1918
• 全文大小：954 K

文摘

Objectives

This study examined the mid-term hemodynamic and clinical impact of prosthesis¨Cpatient mismatch (PPM) in patients undergoing transcatheter aortic valve implantation (TAVI) with balloon-expandable valves.

Background

PPM can be observed after aortic valve surgery. However, little is known about the incidence of PPM in patients undergoing TAVI.

Methods

Echocardiography and clinical assessment were performed in 165 patients at baseline, before hospital discharge, and at 6 months after TAVI. PPM was defined as an indexed effective orifice area ?.85 cm²/m².

Results

Thirty patients (18.2 % ) showed PPM before hospital discharge. At baseline, patients with PPM had a larger body surface area (1.84 ¡À 0.18 m² vs. 1.73 ¡À 0.18 m², p = 0.003) and a greater severity of aortic stenosis (indexed valve area 0.35 ¡À 0.09 cm²/m² vs. 0.40 ¡À 0.10 cm²/m², p = 0.005) than patients without PPM. Patients with PPM demonstrated a slower and smaller reduction in mean transaortic gradient, limited left ventricular (LV) mass regression, and left atrial volume reduction over 6 months compared with patients without PPM. LV filling pressure, measured by E/e? tended to remain elevated in patients with PPM. Importantly, a higher proportion of patients with PPM did not improve in New York Heart Association functional class compared with patients without PPM (36.7 % vs. 1.5 % , p < 0.001), although major adverse valve-related and cardiovascular events did not differ between the 2 groups.

Conclusions

PPM may be observed after TAVI and when present may be accompanied by less favorable changes in transvalvular hemodynamics, limited LV mass regression, persistent elevated LV filling pressure, and less improvement in clinical functional status.