二尖瓣反流与 CoreValve Revalving 系统经导管主动脉瓣置换术的相互作用：一项多中心注册研究。
Interplay between mitral regurgitation and transcatheter aortic valve replacement with the CoreValve Revalving System: a multicenter registry.
机构信息
Department of Cardiology, Istituto Clinico S. Ambrogio, Milan (F.B., M.A., S.P., R.A.L., S.L., S.C., N.B., L.T.); Interventional Cardiology Unit, San Raffaele Hospital and EMO-GVM Centro Cuore Columbus, Milan (A.L., F.M., A.C.); Niguarda Ca Granda Hospital, Milan (F.D.M., J.O., S.K.); Cardiothoracic and Vascular Department, Azienda Ospedaliero-Universitaria Pisana, Pisa (A.S.P., M.D.C.); Cardiothoracic Department, Spedali Civili, Brescia (F.E., C.F.); Azienda Ospedaliera Legnano, Legnano (A.P., S.D.S.); Ospedale di Bassano del Grappa, Vicenza (A.R.); Department of Cardiac Thoracic and Vascular Sciences, University of Padova, Padova (G.T.); Institute of Cardiology, St. Orsola/Malpighi Hospital, Bologna University, Bologna (A.M.); Osp. San Camillo, Roma (R.F.); and Ferrarotto Hospital, Catania (G.P.U., C.T.), Italy.
出版信息
Circulation. 2013 Nov 5;128(19):2145-53. doi: 10.1161/CIRCULATIONAHA.113.001822. Epub 2013 Oct 2.
BACKGROUND
Little is known of the prognostic significance of mitral regurgitation (MR) on transcatheter aortic valve replacement (TAVR), the impact of TAVR on MR severity, and the variables associated with possible post-TAVR improvement in MR. We evaluated these issues in a multicenter registry of patients undergoing CoreValve Revalving System-TAVR.
METHODS AND RESULTS
Among 1007 consecutive patients, 670 (66.5%), 243 (24.1%), and 94 (9.3%) presented with no/mild, moderate, and severe MR, respectively. At 1 month after TAVR, patients with severe or moderate MR showed comparable mortality rates (odds ratio, 1.1; 95% confidence interval [95% CI], 0.7-1.55; P=0.2), but both were significantly higher compared with patients with mild/no MR (odds ratio, 2.2; 95% CI, 1.78-3.28; P<0.001; and odds ratio, 1.9; 95% CI, 1.1-3.3; P=0.02, respectively). One-year mortality was also similar between patients with severe and those with moderate MR (hazard ratio, 1.4; 95% CI, 0.94-2.4; P=0.06) and still significantly higher compared with patients with mild/no MR (hazard ratio, 1.7; 95% CI, 1.2-3.41; P<0.001; and hazard ratio, 1.4; 95% CI, 1.2-2.2; P=0.03, respectively). Severe pulmonary hypertension, atrial fibrillation, and MR more than mild, but not an improvement of ≥1 grade in MR severity, were independent predictors of mortality at 1 year. At 1 year, an improved MR was observed in 47% and 35% of patients with severe and moderate MR, respectively. The rate of low implantation was consistent across groups with improved, unchanged, or worsened MR. A functional type of MR and the absence of severe pulmonary hypertension and atrial fibrillation independently predicted the improvement in MR severity.
CONCLUSIONS
Baseline MR greater than mild is associated with higher mortality after CoreValve Revalving System-TAVR. A significant improvement in MR was more likely in patients with functional MR and without severe pulmonary hypertension or atrial fibrillation. The improvement in MR did not independently predict mortality.
背景
经导管主动脉瓣置换术（TAVR）后二尖瓣反流（MR）的预后意义、TAVR 对 MR 严重程度的影响以及可能与 TAVR 后 MR 改善相关的变量知之甚少。我们在 CoreValve Revalving System-TAVR 的多中心登记处评估了这些问题。
方法和结果
在 1007 例连续患者中，分别有 670 例（66.5%）、243 例（24.1%）和 94 例（9.3%）存在无/轻度、中度和重度 MR。TAVR 后 1 个月，重度或中度 MR 患者的死亡率相当（比值比，1.1；95%置信区间[95%CI]，0.7-1.55；P=0.2），但均明显高于轻度/无 MR 患者（比值比，2.2；95%CI，1.78-3.28；P<0.001；比值比，1.9；95%CI，1.1-3.3；P=0.02）。重度和中度 MR 患者的 1 年死亡率也相似（风险比，1.4；95%CI，0.94-2.4；P=0.06），且仍明显高于轻度/无 MR 患者（风险比，1.7；95%CI，1.2-3.41；P<0.001；风险比，1.4；95%CI，1.2-2.2；P=0.03）。重度肺动脉高压、心房颤动和 MR 比轻度更严重，但 MR 严重程度改善≥1 级并不是 1 年死亡率的独立预测因素。1 年后，重度和中度 MR 患者中分别有 47%和 35%的患者 MR 得到改善。MR 改善、不变或恶化的患者中，低植入率一致。功能性 MR 类型和无重度肺动脉高压及心房颤动是 MR 严重程度改善的独立预测因素。
结论
基线 MR 大于轻度与 CoreValve Revalving System-TAVR 后死亡率升高有关。功能性 MR 患者且无重度肺动脉高压或心房颤动患者，MR 改善的可能性更大。MR 的改善不能独立预测死亡率。
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