Quebec Heart and Lung Institute, Laval University, Canada (L.d.F.C.G., J.-M.P., E.D., P.P., J.R.-C.).
Bichat-Claude Bernard University Hospital, Paris, France (M.U., Q.F., D.H.).
Circ Cardiovasc Interv. 2018 Sep;11(9):e007038. doi: 10.1161/CIRCINTERVENTIONS.118.007038.
Data on long-term outcomes after valve-in-valve (ViV) transcatheter aortic valve replacement (TAVR) are scarce. The objective of this study was to determine the long-term clinical outcomes and structural valve degeneration (SVD) over time in patients undergoing ViV-TAVR.
Consecutive patients undergoing ViV-TAVR in 9 centers between 2009 and 2015 were included. Patients were followed yearly, and clinical and echocardiography data were collected prospectively. SVD was defined as subclinical (increase >10 mm Hg in mean transvalvular gradient+decrease >0.3 cm in valve area or new-onset mild or moderate aortic regurgitation) and clinically relevant (increase >20 mm Hg in mean transvalvular gradient+decrease >0.6 cm in valve area or new-onset moderate-to-severe aortic regurgitation). A total of 116 patients (mean age, 76±11 years; 64.7% male; mean Society of Thoracic Surgeons score, 8.0±5.1%) were included. Balloon- and self-expandable valves were used in 47.9% and 52.1% of patients, respectively, and 30-day mortality was 6.9%. At a median follow-up of 3 years (range, 2-7 years), 30 patients (25.9%) had died, 20 of them (17.2%) from cardiovascular causes. Average mean transvalvular gradients remained stable up to 5-year follow-up ( P=0.92), but clinically relevant SVD occurred in 3/99 patients (3.0%), and 15/99 patients (15.1%) had subclinical SVD. One patient with SVD had redo ViV-TAVR.
About one-fourth of ViV-TAVR recipients had died after a median follow-up of 3 years. Overall valve hemodynamics remained stable over time and clinically relevant SVD was infrequent, but 1 out of 10 patients exhibited some degree of SVD.
关于经导管主动脉瓣置换术（TAVR）后经瓣中瓣（ViV）治疗的长期结果的数据很少。本研究的目的是确定在接受 ViV-TAVR 的患者中，随着时间的推移，临床结果和结构性瓣膜退化（SVD）的长期变化。
连续纳入了 2009 年至 2015 年在 9 个中心接受 ViV-TAVR 的患者。患者每年接受随访，前瞻性地收集临床和超声心动图数据。SVD 定义为亚临床（平均跨瓣梯度增加>10mmHg+瓣口面积减少>0.3cm 或新发轻度或中度主动脉瓣反流）和临床相关（平均跨瓣梯度增加>20mmHg+瓣口面积减少>0.6cm 或新发中度至重度主动脉瓣反流）。共纳入 116 例患者（平均年龄 76±11 岁；64.7%为男性；平均胸外科医师协会评分 8.0±5.1%）。球囊扩张瓣膜和自膨式瓣膜分别在 47.9%和 52.1%的患者中使用，30 天死亡率为 6.9%。中位随访 3 年（范围 2-7 年），30 例（25.9%）患者死亡，其中 20 例（17.2%）死于心血管原因。平均跨瓣梯度在 5 年随访时保持稳定（P=0.92），但有 3/99 例（3.0%）患者发生临床相关 SVD，15/99 例（15.1%）患者发生亚临床 SVD。1 例 SVD 患者接受了再次 ViV-TAVR。
在中位随访 3 年后，约四分之一的 ViV-TAVR 接受者死亡。随着时间的推移，整体瓣膜血流动力学保持稳定，临床相关 SVD 并不常见，但每 10 例患者中就有 1 例存在一定程度的 SVD。
