Comparison Of Hemodynamics And Left Ventricular Mass Regression Between TAVI And SAVR With Simple Interrupted Suturing Technique
Kazuhiro Naito, Kin Hajime, Kazutoshi Tachibana, Kosaku Nishigawa, Shuichiro Takanashi.
Sakakibara Heart Institute, Tokyo, Japan.
BACKGROUND: Superiority of transcatheter aortic valve implantation (TAVI) in terms of hemodynamics had been reported compared with surgical aortic valve replacement (SAVR). This study compared hemodynamic performance of bioprosthesis and its effect on left ventricular mass in SAVR performed with simple interrupted suturing technique with TAVI for small body size patients. METHODS: This is retrospective single center study. From January 2010 to June 2014, 319 patients with BSA < 1.5m2 underwent SAVR or TAVI for severe AS. Of those, bioprosthetic SAVR with simple interrupted sutures was performed in 245 (group S), and balloon-expandable TAVI (with Sapien XT) in 73 (group T). SAVR with concomitant mitral and aortic surgery were excluded. Treatment allocation was decided with discussions among heart team members. Outcome measures were mean pressure gradient (MPG), effective orifice area index (EOAI), aortic regurgitation (AR), left ventricular mass index (LVMI) at 1 year, and LVMI regression for 1 year. RESULTS: Patients background and echocardiographic data were summarized in a table. At 1 year, there were no significant difference in MPG (12.3±4.8 vs. 12.9±5.6 mmHg; p=0.383), EOAI (1.06 ±0.26 vs. 1.06 ±0.25 cm2; p=0.909) between both groups. AR (p<0.001) were significantly lesser in group S than in group T. LVMI regression (-25.5±33.2 vs. -8.7±33.0 g/m2; p<0.001) was significantly greater in group S than in group T. A multiple regression analysis showed treatment modality did not related to hemodynamic valve performance in terms of MPG (p=0.506) and EOAI (p=0.453) , although SAVR related to greater LVMI regression (p<0.001) after control of confounding factors and covariates. CONCLUSIONS: SAVR with simple interrupted suturing technique related to greater LVMI regression for 1 year compared with TAVI for patients with small body size. although MPG and EOAI were comparable.
|Group S (N=245)||Group T (N=74)||p|
|Age (years old)||78.8 ±6.0||84.1 ±5.9)||<0.001|
|Female||236 (96.3%)||74 (100%)||0.124|
|BSA (m2)||1.36 ± 0.10||1.31 ± 0.11||0.002|
|BMI||21.8 ±3.4||21.3 ±3.4||0.237|
|Coronary artery disease||114 (46.5%)||23 (31.3%)||0.023|
|Ejection fraction (%)||61.0 ± 9.0||59.9 ± 8.6||0.360|
|LVMI (g/m2)||117.0 ±33.9||125.3 ± 45.6||0.091|
|Annular diameter (mm)||20.6 ± 1.9||19.9 ± 1.8||0.009|
|MPG (mmHg)||58.4 ± 24.4||59.0 ± 20.5||0.852|
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