■经导管主动脉瓣置换术(TAVR)后的主动脉瓣返流(AR)是短期和长期生存的主要预测指标。到目前为止,尚未对市售的经导管心脏瓣膜(THV)进行AR的独立定量比较.
■我们试图评估和比较11种市售THV之间TAVR后急性AR的程度,并更新我们以前的多中心,汇集分析。
■由独立的学术核心实验室使用定量视频密度测定法进行分析,一种仅依赖于TAVR后获得的主动脉造影的技术。汇总分析(n=2665)包括来自7个瓣膜的初始队列的数据(Lotus[n=546],EvolutPRO[n=95],SAPIEN3[n=397],EvolutR[n=295],SAPIENXT[n=239],ACURATEneo[n=120],和CoreValve[n=532]),其中添加了来自4个新阀门的数据(ACURATEneo2[n=120],Myval[n=108],VitaFlow[n=105],和金星A[n=113])。
■莲花瓣膜的平均AR最低(3.5%±4.4%),其次是ACURATEneo2(4.4%±4.8%),VitaFlow(6.1%±6.4%),Myval(6.3%±6.3%),EvolutPRO(7.4%±6.5%),SAPIEN3(7.6%±7.1%),EvolutR(7.9%±7.4%),SAPIENXT(8.8%±7.5%),金星A(8.9%±10%),急性新(9.6%±9.2%),和CoreValve(13.7%±10.7%,方差分析P值<.001)。统计上唯一与所有阀门不同的是莲花,与其他瓣膜相比,反流最低,除了ACURATEneo2,与SAPIEN3,EvolutR相比,反流较少,SAPIENXT,维纳斯A,ACURATENEO,和CoreValve。CoreValve的平均AR最高,中度/重度AR的发生率:ACURATEneo2(1.7%),莲花(2.2%),Myval(2.8%),VitaFlow(4.7%),EvolutPRO(5.3%),萨普3(8.3%),EvolutR(8.8%),SAPIENXT(10.9%),急性新(11.3%),金星A(14.2%),和CoreValve(30.1%)-χ2P值<.001。
■在此更新的汇总分析中,莲花阀门的平均AR最低,而ACURATEneo2的中度/重度AR发生率最低。Myval,VitaFlow,和Venus-ATHV显示出有希望的结果。
UNASSIGNED: Aortic regurgitation (AR) following transcatheter aortic valve replacement (TAVR) is a major predictor of short- and long-term survival. Thus far, no independent quantitative comparison of AR among commercially available transcatheter heart valves (THVs) has been performed.
UNASSIGNED: We sought to assess and compare the degree of acute AR following TAVR between 11 commercially available THVs and update our previous multicenter, pooled analysis.
UNASSIGNED: Analyses were performed by an independent academic core lab using quantitative videodensitometry, a technique relying solely on the aortogram acquired after TAVR. The pooled analysis (n = 2665) included data from the initial cohort of 7 valves (Lotus [n = 546], Evolut PRO [n = 95], SAPIEN 3 [n = 397], Evolut R [n = 295], SAPIEN XT [n = 239], ACURATE neo [n = 120], and CoreValve [n = 532]) to which data from 4 new valves were added (ACURATE neo2 [n = 120], Myval [n = 108], VitaFlow [n = 105], and Venus-A [n = 113]).
UNASSIGNED: The Lotus valve had the lowest mean AR (3.5% ± 4.4%) followed by ACURATE neo2 (4.4% ± 4.8%), VitaFlow (6.1% ± 6.4%), Myval (6.3% ± 6.3%), Evolut PRO (7.4% ± 6.5%), SAPIEN 3 (7.6% ± 7.1%), Evolut R (7.9% ± 7.4%), SAPIEN XT (8.8% ± 7.5%), Venus-A (8.9% ± 10%), ACURATE neo (9.6% ± 9.2%), and CoreValve (13.7% ± 10.7%, analysis of variance P-value < .001). The only valves that statistically differed from all their counterparts were Lotus, with the lowest regurgitation in comparison to other valves except ACURATE neo2, which had less regurgitation compared with SAPIEN 3, Evolut R, SAPIEN XT, Venus-A, ACURATE neo, and CoreValve. CoreValve had the highest mean of AR, with the rates of moderate/severe AR: ACURATE neo2 (1.7%), Lotus (2.2%), Myval (2.8%), VitaFlow (4.7%), Evolut PRO (5.3%), SAPIEN 3 (8.3%), Evolut R (8.8%), SAPIEN XT (10.9%), ACURATE neo (11.3%), Venus-A (14.2%), and CoreValve (30.1%)-χ2 P-value < .001.
UNASSIGNED: In this updated pooled analysis, the Lotus valve had the lowest mean AR, while ACURATE neo2 had the lowest rate of moderate/severe AR. Myval, VitaFlow, and Venus-A THVs showed promising results.