부산대학교 도서관

Purpose: The transcatheter aortic valve implantation (TAVI) has proved to be an alternative treatment for severe aortic stenosis in high risk patients. New surgical techniques with autoexpandibles suturless aortic valve protheses have shown good results with a less invasive surgical approach and a reduction in surgical time. The purpose of the study was to compare initial echocardiographic results after aortic valve implantation by both techniques. Methods: We studied 142 consecutive patients submitted to TAVI and 33 patients submitted to aortic valve replacement (AVR) with autoexpandibles sutureless Perceval valves. Clinical and demographic variables were registered and a transthoracic echocardiography study was performed before the implantation and after the procedure or surgery. Maximum and mean aortic gradients were registered as well as the paravalvular aortic regurgitation (AR). The latter was classified in two grades: I= null o mild; II= moderate or severe. Results: The 142 patients submitted to TAVI were diagnosed of symptomatic severe aortic stenosis with a high surgical risk (Logistic EuroSCORE 10,4 ± 7,8), and higher age than the ones submitted to surgery (81,8 vs. 79,8; p=0,005). From the 33 patients submitted to AVR with Perceval protheses, 5 of them (15%) were also performed a coronary artery bypass graft. The incidence of paravalvular AR was grade I (null o mild) in 25 patients (86%), and grade II (moderate or severe) in 4 (14%). In patients with TAVI, 94 of them (69,1%) presented null or minimum paravalvular AR, while in the 42 remaining patients (30,9%) it was grade II, with statistically significant differences between the 2 types of protheses ( p=0,046). Both protheses presented similar aortic gradients in the study after the implantation, without statistically significant differences between TAVI and Perceval protheses in maximum Doppler gradient (20,98 vs. 23,87 mmHg; p= 0.152) and mean gradient (11,16 vs. 13,31 mmHg; p=0.063). The relation between time-velocity integral of the LV outflow tract and aortic valve after the implantation was also similar between both groups (median 0,55 vs. 0,53; p= 0,228). Conclusions: The early echocardiographic study after the implantation of autoexpandible aortic protheses shows comparable results between both types of protheses in terms of gradients, with a higher incidence of paravalvular aortic regurgitation in the group of TAVI.