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SAVR Vs TAVR In Hemodynamic Status
Ryoji Kinoshita, Youshun Sai, Hiroyuki Tanaka, Kazunobu Hirooka.
Tsuchiura Kyodo General Hospital, Tsuchiura city, Ibaraki, Japan.

BACKGROUND: There have been many clinical trials comparing SAVR and TAVR. There are reports that define structural valve deterioration as mean pressure gradient (meanPG) >20 mmHg and conclude hemodynamic inferiority of SAVR based only on this definition. We will examine the hemodynamic status of SAVR and TAVR based on our in vivo data.
METHODS: A total of 125 patients underwent SAVR (group S) and 62 patients underwent TAVR (group T) for severe AS from April 2013 to August 2019. The results of transthoracic echocardiography (TTE) in the postoperative period and early follow-up period were compared.
RESULTS: There were more elderly and smaller patients in the T group, but in the preoperative TTE, there was no difference in LVEF, Left ventricular mass index (LVMI), and aortic annulus diameter. The valves in group S [Mitroflow:5, Crown:7, Magna:8, Inspiris:9, Mosaic:2, Avalus:4, Trifecta:90], and the use of Trifecta was 72%; in group T, Sapien3 was used in all cases. The valve size was S group [19mm:50 21mm:47 23mm:25 25mm:3] and T group [20mm:7 23mm:38 26mm:15 29mm:2]. In the postoperative TTE, there was no significant difference in meanPG (13.5 vs. 12.9 mmHg, p=0.47), meanPG >20 mmHg (19/125 vs. 6/62, p=0.37). The reduction rate in LVMI was 26.0% in the S group and 15.3% in the T group (p=0.002) with a mean observation period of about 1 year. On the other hand, when the results of postoperative TTE were compared between the non-Trifecta S group (n=35) and the T group, the non-Trifecta S group was significantly inferior in meanPG (17.0 vs. 12.9 mmHg, p=0.002) and meanPG >20 mmHg (12/35 vs. 6/62, p=0.005). However, when comparing the reduction rate of LVMI, the non-Trifecta S group showed a greater reduction rate (25.7% vs. 15.3%, p=0.004).
CONCLUSIONS: There was no hemodynamic difference between SAVR with aggressive use of Trifecta and TAVR with Sapien3. In addition, the non-Trifecta SAVR group, which was inferior to the Sapien3-implanted TAVR in terms of pressure gradients, showed better results in reducing LVMI, suggesting that the hemodynamic superiority of TAVR should not be based solely on the pressure gradients of the implanted valve.


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