Rigshospitalet, Copenhagen, Denmark.
Inselspital, Bern, Switzerland.
Am J Cardiol. 2018 Sep 15;122(6):1028-1035. doi: 10.1016/j.amjcard.2018.05.044. Epub 2018 Jun 27.
Patients with pure native aortic valve regurgitation (NAVR) and increased surgical risk are often denied surgery. This retrospective study aimed to evaluate the "off-label" use of transcatheter heart valves (THV) for the treatment of NAVR. A total of 254 high surgical risk patients with NAVR (age 74 ± 12 years, Society of Thoracic Surgeons risk score 6.6 ± 6.2%) underwent transcatheter aortic valve implantation (TAVI) with early generation (43%) or newer generation (57%) devices at 46 different sites. Device success was significantly higher in patients treated with newer as compared with early generation THV (82% vs 47%, p <0.001). The difference was driven by lower rates of device malpositioning (9% vs 33%) and aortic regurgitation (AR) ≥ moderate (4% vs 31%) and translated into higher clinical efficacy at 30 days in patients treated with newer as compared with early generation THV (72% vs 56%, p = 0.041). Both THV under- and oversizing were associated with an increased risk of THV malpositioning. In conclusion, TAVI is a feasible treatment strategy in selected high-risk patients with NAVR but is associated with a considerable risk of THV malpositioning and residual AR. Although newer-generation THV are associated with better outcomes, novel devices for the treatment of NAVR are warranted.
患有单纯原发性主动脉瓣反流（NAVR）且手术风险增加的患者通常会被拒绝手术。本回顾性研究旨在评估经导管心脏瓣膜（THV）在治疗 NAVR 中的“超适应证”使用。共有 254 名高手术风险的 NAVR 患者（年龄 74 ± 12 岁，胸外科医师协会风险评分 6.6 ± 6.2%）在 46 个不同部位接受了经导管主动脉瓣植入术（TAVI），使用的器械为早期一代（43%）或新一代（57%）。与早期一代 THV 相比，使用新一代 THV 的患者器械成功率显著更高（82%比 47%，p<0.001）。差异的原因是器械定位不当（9%比 33%）和主动脉瓣反流（AR）≥中度（4%比 31%）的发生率较低，这在使用新一代 THV 的患者中转化为 30 天更高的临床疗效（72%比 56%，p=0.041）。THV 大小不当和过度均与 THV 定位不当的风险增加相关。总之，TAVI 是一种可行的治疗策略，适用于选择的高风险 NAVR 患者，但与 THV 定位不当和残余 AR 的风险较高相关。尽管新一代 THV 与更好的结果相关，但仍需要用于治疗 NAVR 的新型器械。
