Amat-Santos Ignacio J, Castrodeza Javier, Nombela-Franco Luis, Muñoz-García Antonio J, Gutiérrez-Ibanes Enrique, de la Torre Hernández José M, Córdoba-Soriano Juan G, Jiménez-Quevedo Pilar, Hernández-García José M, González-Mansilla Ana, Ruano Javier, Tobar Javier, Del Trigo María, Vera Silvio, Puri Rishi, Hernández-Luis Carolina, Carrasco-Moraleja Manuel, Gómez Itziar, Rodés-Cabau Josep, San Román José A
Departamento de Cardiología, CIBERCV, Hospital Clínico Universitario, Valladolid, Spain.
Departamento de Cardiología, CIBERCV, Hospital Clínico Universitario, Valladolid, Spain.
Rev Esp Cardiol (Engl Ed). 2018 May;71(5):357-364. doi: 10.1016/j.rec.2017.08.019. Epub 2017 Oct 27.
Many patients undergoing transcatheter aortic valve implantation (TAVI) have concomitant mitral regurgitation (MR) of moderate grade or less. The impact of coexistent tricuspid regurgitation (TR) remains to be determined. We sought to analyze the impact of moderate vs none-to-mild MR and its trend after TAVI, as well as the impact of concomitant TR and its interaction with MR.
Multicenter retrospective study of 813 TAVI patients treated through the transfemoral approach with MR ≤ 2 between 2007 and 2015.
The mean age was 81 ± 7 years and the mean Society of Thoracic Surgeons score was 6.9% ± 5.1%. Moderate MR was present in 37.3% of the patients, with similar in-hospital outcomes and 6-month follow-up mortality to those with MR < 2 (11.9% vs 9.4%; P = .257). However, they experienced more rehospitalizations and worse New York Heart Association class (P = .008 and .001, respectively). Few patients (3.8%) showed an increase in the MR grade to > 2 post-TAVI. The presence of concomitant moderate/severe TR was associated with in-hospital and follow-up mortality rates of 13% and 34.1%, respectively, regardless of MR grade. Moderate-severe TR was independently associated with mortality (HR, 18.4; 95%CI, 10.2-33.3; P < .001).
The presence of moderate MR seemed not to impact short- and mid-term mortality post-TAVI, but was associated with more rehospitalizations. The presence of moderate or severe TR was associated with higher mortality. This suggests that a thorough evaluation of the mechanisms underlying concomitant mitral and tricuspid valve regurgitation should be performed to determine the best strategy for avoiding TAVI-related futility.
许多接受经导管主动脉瓣植入术（TAVI）的患者同时存在中度或以下的二尖瓣反流（MR）。并存的三尖瓣反流（TR）的影响仍有待确定。我们试图分析中度与无至轻度MR的影响及其在TAVI后的变化趋势，以及并存TR的影响及其与MR的相互作用。
对2007年至2015年间通过股动脉途径治疗且MR≤2的813例TAVI患者进行多中心回顾性研究。
平均年龄为81±7岁，胸外科医师协会平均评分是6.9%±5.1%。37.3%的患者存在中度MR，其住院结局和6个月随访死亡率与MR<2的患者相似（11.9%对9.4%；P = 0.257）。然而，他们再次住院的情况更多，纽约心脏协会心功能分级更差（分别为P = 0.008和0.001）。少数患者（3.8%）在TAVI后MR分级增加至>2。无论MR分级如何，并存中度/重度TR与住院和随访死亡率分别为13%和34.1%相关。中度至重度TR与死亡率独立相关（HR，18.4；95%CI，10.2 - 33.3；P < 0.001）。
中度MR的存在似乎不影响TAVI后的短期和中期死亡率，但与更多的再次住院相关。中度或重度TR的存在与更高的死亡率相关。这表明应彻底评估二尖瓣和三尖瓣反流并存的潜在机制，以确定避免TAVI相关无效治疗的最佳策略。
