Ielasi Alfonso, Latib Azeem, Sacco Francesco Maria, Costopoulos Charis, Figini Filippo, Grimaldi Antonio, Naim Charbel, Maisano Francesco, Chieffo Alaide, Montorfano Matteo, Alfieri Ottavio, Colombo Antonio
aInterventional Cardiology Unit, San Raffaele Scientific Institute bInterventional Cardiology Unit, EMO-GVM Centro Cuore Columbus cDivision of Cardiac Surgery, San Raffaele Scientific Institute, Milan, Italy *Dr Alfonso Ielasi and Dr Azeem Latib contributed equally to the article and are joint first authors.
J Cardiovasc Med (Hagerstown). 2015 Apr;16(4):286-95. doi: 10.2459/JCM.0000000000000249.
Post-procedural aortic regurgitation (AR) negatively impacts the prognosis after trans-catheter aortic valve implantation. However, data evaluating the impact of different post-procedural AR grades (particularly mild) on clinical outcomes are still important.
A retrospective cohort analysis was performed on all consecutive patients with severe aortic stenosis who underwent trans-catheter aortic valve implantation between July 2008 and August 2011 in a single Institution. Aim of the study was to evaluate the impact of different post-procedural AR grades on early and mid-term clinical outcomes.
322 consecutive patients were evaluated. At post-procedural echocardiographic evaluation: 105 (32.6%) patients had no AR, 204 (63.4%) mild AR and 13 (4%) moderate/severe AR. In-hospital mortality was higher in patients with moderate/severe AR than in those with absent or mild AR (38.5% vs. 2.6%, P < 0.001). At a median clinical follow-up of 342 days [interquartile range 93-485] cardiovascular mortality was 2.9% in patients without AR; 13.2% in the mild AR group (P = 0.004 vs. absent AR) and 46.2% in the moderate/severe AR group (P < 0.001 vs. mild or absent AR). On multivariable analysis, post-procedural AR (hazard ratio = 2.65 absent vs. present any grade, 95% confidence interval = 1.11-6.29; P = 0.027) was an independent predictor of mid-term mortality.
The impact of post-procedural AR on outcomes after trans-catheter aortic valve implantation is proportional with its grade even in case of mild post-procedural AR compared to absent. This study confirms that every effort should be made to reduce the grade of post-procedural AR after trans-catheter aortic valve implantation with current devices.
经导管主动脉瓣植入术后的主动脉瓣反流（AR）对预后产生负面影响。然而，评估不同程度的术后AR（尤其是轻度）对临床结局影响的数据仍然很重要。
对2008年7月至2011年8月期间在单一机构接受经导管主动脉瓣植入术的所有连续性重度主动脉瓣狭窄患者进行回顾性队列分析。本研究的目的是评估不同程度的术后AR对早期和中期临床结局的影响。
共评估了322例连续性患者。术后超声心动图评估显示：105例（32.6%）患者无AR，204例（63.4%）为轻度AR，13例（4%）为中度/重度AR。中度/重度AR患者的院内死亡率高于无AR或轻度AR患者（38.5%对2.6%，P<0.001）。在中位临床随访342天[四分位间距93 - 485]时，无AR患者的心血管死亡率为2.9%；轻度AR组为13.2%（与无AR组相比，P = 0.004），中度/重度AR组为46.2%（与轻度或无AR组相比，P<0.001）。多变量分析显示，术后AR（风险比=2.65，无AR与任何程度存在AR相比，95%置信区间=1.11 - 6.29；P = 0.027）是中期死亡率的独立预测因素。
经导管主动脉瓣植入术后AR对结局的影响与其程度成正比，即使是轻度术后AR与无AR相比也是如此。本研究证实，应尽一切努力使用现有装置降低经导管主动脉瓣植入术后的AR程度。
