经导管主动脉瓣置换术使用 Edwards Sapien 瓣膜患者的二尖瓣反流：机制与术后早期变化。
Mitral regurgitation in patients referred for transcatheter aortic valve implantation using the Edwards Sapien prosthesis: mechanisms and early postprocedural changes.
机构信息
Department of Cardiology, AP-HP, Bichat Hospital, Paris, France.
出版信息
J Am Soc Echocardiogr. 2012 Feb;25(2):160-5. doi: 10.1016/j.echo.2011.10.001. Epub 2011 Nov 8.
BACKGROUND
Transcatheter aortic valve implantation (TAVI) is an alternative to conventional surgery in high-risk patients with severe aortic stenosis (AS), but data regarding mitral regurgitation (MR) characteristics and changes after TAVI are sparse.
METHODS
A total of 254 patients with severe AS referred for TAVI were prospectively enrolled. Comprehensive echocardiography was performed at baseline and at 7 days and 1 month in patients who underwent TAVI. MR was semiquantitatively graded from 0 to 4. Overlap of the anterior mitral leaflet and the device was measured using transesophageal echocardiography immediately after TAVI.
RESULTS
At screening, MR was absent in 26%, grade 1 in 44%, grade 2 in 25%, and grade ≥3 in 5% and was organic in 68% and functional in 32%. TAVI was finally performed using the Edwards Sapien valve in 119 patients, including four with MR grade ≥ 3. MR grade significantly decreased at 7 days (P = .003) but remained unchanged at 1 month (P = .55), whereas reverse remodeling occurred only at 1 month (improvements in left ventricular [LV] end-systolic diameter and ejection fraction; P < .05 for both). MR changes over time significantly differed according to ejection fraction and LV diameters (all P values for interaction < .005) but not according to aortic mean gradient, MR etiology, or overlap of the anterior mitral leaflet and the device (all P values for interaction > .15).
CONCLUSIONS
In patients referred for TAVI, MR is common, mainly organic, and rarely severe. After TAVI, MR improved within 7 days in both organic and functional MR, was not influenced by overlap of the anterior mitral leaflet and the device, but was associated with improvement in LV ejection fraction. Possible MR improvement should be taken into account in patient selection for TAVI especially, in cases of LV dysfunction or enlargement and MR of borderline severity.
背景
经导管主动脉瓣植入术（TAVI）是高危重度主动脉瓣狭窄（AS）患者的一种替代传统手术的方法，但关于 TAVI 后二尖瓣反流（MR）特征和变化的数据很少。
方法
共前瞻性纳入 254 例拟行 TAVI 的重度 AS 患者。所有患者均在 TAVI 前行全面超声心动图检查，并于 TAVI 后 7 天和 1 个月时进行检查。MR 采用半定量分级 0-4 级。TAVI 后即刻行经食管超声心动图测量前二尖瓣叶与器械的重叠。
结果
在筛查时，MR 为 0 级的占 26%，1 级的占 44%，2 级的占 25%，≥3 级的占 5%，其中 68%为器质性，32%为功能性。最终，119 例患者使用 Edwards Sapien 瓣膜进行 TAVI，其中 4 例存在 MR≥3 级。7 天时 MR 显著降低（P=0.003），但 1 个月时无变化（P=0.55），而仅在 1 个月时出现逆向重构（左心室[LV]收缩末期直径和射血分数改善；均 P<0.05）。MR 随时间的变化与射血分数和 LV 直径显著相关（所有交互 P 值<0.005），但与主动脉平均梯度、MR 病因或前二尖瓣叶与器械的重叠无关（所有交互 P 值>0.15）。
结论
在拟行 TAVI 的患者中，MR 很常见，主要为器质性，很少为严重的。在 TAVI 后，器质性和功能性 MR 在 7 天内均有改善，不受前二尖瓣叶与器械重叠的影响，但与 LV 射血分数的改善相关。在选择 TAVI 患者时，特别是在 LV 功能障碍或扩大以及 MR 处于临界严重程度时，应考虑可能的 MR 改善。
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