Elucidation of the mechanism of long-term deterioration of cardiac function after transcatheter arterial valve implantation and its investigation in animal models

• Project/Area Number: 16K09452
• Research Category: Grant-in-Aid for Scientific Research (C)
• Allocation Type: Multi-year Fund
• Section: 一般
• Research Field: Cardiovascular medicine
• Research Institution: Keio University
• Principal Investigator: Itabashi Yuji 慶應義塾大学, 医学部(信濃町), 講師 (00317108)
• Project Period (FY): 2016-04-01 – 2021-03-31
• Project Status: Completed (Fiscal Year 2020)
• Budget Amount: ¥4,810,000 (Direct Cost: ¥3,700,000、Indirect Cost: ¥1,110,000); Fiscal Year 2020: ¥390,000 (Direct Cost: ¥300,000、Indirect Cost: ¥90,000); Fiscal Year 2019: ¥910,000 (Direct Cost: ¥700,000、Indirect Cost: ¥210,000); Fiscal Year 2018: ¥780,000 (Direct Cost: ¥600,000、Indirect Cost: ¥180,000); Fiscal Year 2017: ¥910,000 (Direct Cost: ¥700,000、Indirect Cost: ¥210,000); Fiscal Year 2016: ¥1,820,000 (Direct Cost: ¥1,400,000、Indirect Cost: ¥420,000)
• Keywords: 経カテーテル大動脈弁植え込み術 / 心拍出量 / 右心機能 / 三尖弁閉鎖不全症 / 大動脈弁逆流症 / 経皮的大動脈弁埋め込み術 / 大動脈弁狭窄症 / 大動脈弁閉鎖不全症 / 経皮的大動脈弁植え込み術 / 拡張型心筋症 / 心不全

Outline of Final Research Achievements

The purpose of this study was to investigate patients who had undergone transcatheter aortic valve implantation (TAVI) and whose cardiac function did not improve sufficiently, and to investigate the appropriate indications for TAVI based on the findings of the study. In patients with improved right ventricular contractility, cardiac output tended to increase after TAVI. It was also found that patients with reduced tricuspid valve annular contractility tended to have less improvement in tricuspid regurgitation after TAVI.

Academic Significance and Societal Importance of the Research Achievements

大動脈狭窄症に対しては外科的弁置換術もしくはTAVIを実施する必要がある。大動脈弁狭窄症に伴って発症した三尖弁逆流はTAVIを行うだけで改善する症例がいるものの、大動脈弁狭窄が解除された後も有意な三尖弁逆流が遷延する症例も稀ではない。高齢者などでは負担の少ないTAVIで大動脈弁狭窄症を治療するメリットは大きいが、大動脈弁狭窄解除後も三尖弁逆流が遷延すると予測される患者においては手術リスクを容認した上で外科手術を実施しなければならない症例も存在する。従ってTAVI実施後も三尖弁逆流が残存してしまう症例を見つけることで、正しい治療法を選択する際に有用な情報を発信することができたと考える。

Research Products

• [Journal Article] Impact of preprocedural echocardiographic parameters on increased stroke volume after transcatheter aortic valve replacement (2019)
  • Author(s): Kohsuke Shirakawa
  • Journal Title: AsiaIntervention Volume: 5 Issue: 1 Pages: 1-8
  • DOI: 10.4244/aij-d-18-00021
  • Peer Reviewed
• [Presentation] 心房中隔欠損症に伴う三尖弁逆流の機序および残存リスクの検討：三次元経食道心エコーを 用いた形態解析 (2021)
  • Author(s): 品田慶太郎
  • Organizer: 日本心エコ－図学会 第32回学術集会
• [Presentation] Morphological Analysis of Functional Tricuspid Regurgitation in Patients with Secundum Atrial Septal Defect Using Three-Dimensional Transthoracic Echocardiography (2020)
  • Author(s): Keitaro Shinada, Yuji Itabashi, Hideaki Kanazawa, Kotaro Miura, Mai Kimura, Jin Endo, Hikaru Tsuruta, Mitsushige Murata, Keiichi Fukuda
  • Organizer: 日本循環器学会
• [Presentation] Reduced Aortic Regurgitation and Improved Right Ventricular Contraction Lead to Increased Stroke Volume after Transcatheter Aortic Valve Implantation (2018)
  • Author(s): Yuji Itabashi
  • Organizer: 日本循環器学会
  • Int'l Joint Research
• [Presentation] TAVI 後心拍出量増加の意義と術前予測因子の検討 (2017)
  • Author(s): 白川公亮
  • Organizer: 日本心エコ－図学会第28回学術集会
  • Place of Presentation: 名古屋国際会議場（愛知県名古屋市）
  • Year and Date: 2017-04-21