Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, Bern, Switzerland.
Institute of Social and Preventive Medicine and Clinical Trials Unit, University of Bern, Mittelstrasse 43, Bern, Switzerland.
Eur Heart J. 2019 May 1;40(17):1342-1351. doi: 10.1093/eurheartj/ehy834.
Multivalvular disease is of increasing concern in elderly patients undergoing transcatheter aortic valve replacement (TAVR). The objective of the present analysis was to investigate the impact of concomitant mitral stenosis (MS) on clinical outcomes in patients undergoing TAVR for severe, symptomatic aortic stenosis (AS).
Among 1339 patients undergoing TAVR between August 2007 and December 2015, adequate echocardiographic data for the assessment of severity and aetiology of MS was available in 971 (72.5%) patients. Patients were stratified according to degree and aetiology of concomitant MS. Mitral stenosis was documented in 176 (18.1%) TAVR patients (mean mitral valve area 1.9 ± 0.4 cm2) and considered degenerative in 110 (62.5%) and rheumatic in 66 (37.5%) patients, respectively. Mitral stenosis was categorized as moderate/severe in 28 patients (2.9%). Baseline characteristics were comparable between patients with vs. without MS. At 1 year, patients with MS were at increased risk of cardiovascular death [36 (21.4%) vs. 66 (8.7%); adjusted hazard ratio (HRadj) 3.64, 95% confidence interval (CI) 2.38-5.56] and disabling stroke [12 (7.1%) vs. 23 (3.0%); HRadj 2.98, 95% CI 1.46-6.09] as compared to patients without MS. Differences in cardiovascular death and disabling stroke emerged within 30 days of the index procedure and were largely driven by a difference in patients with rheumatic MS [cardiovascular death: 7 (10.6%) vs. 24 (3.2%), HRadj 4.80, 95% CI 1.98-11.6; disabling stroke: 4 (6.1%) vs. 16 (2.0%), HRadj 4.18, 95% CI 1.34-13.0].
Concomitant MS was documented in approximately one-fifth of patients undergoing TAVR for severe, symptomatic AS and associated with a three-fold increased risk of cardiovascular adverse events at 1 year. The difference emerged early and was largely driven by patients with rheumatic MS.
在接受经导管主动脉瓣置换术（TAVR）的老年患者中，多瓣膜疾病的关注度日益增加。本分析的目的是研究在因严重症状性主动脉瓣狭窄（AS）而接受 TAVR 的患者中，同时存在二尖瓣狭窄（MS）对临床结局的影响。
在 2007 年 8 月至 2015 年 12 月期间接受 TAVR 的 1339 例患者中，971 例（72.5%）患者有足够的超声心动图数据可用于评估 MS 的严重程度和病因。根据同时存在的 MS 的严重程度和病因对患者进行分层。在 176 例 TAVR 患者（平均二尖瓣瓣口面积 1.9±0.4cm2）中发现了二尖瓣狭窄，其中 110 例（62.5%）为退行性病变，66 例（37.5%）为风湿性病变。二尖瓣狭窄中度/重度患者 28 例（2.9%）。有和无 MS 患者的基线特征无差异。1 年后，MS 患者心血管死亡风险增加[36（21.4%）比 66（8.7%）；调整后危险比（HRadj）3.64，95%置信区间（CI）2.38-5.56]和致残性卒中[12（7.1%）比 23（3.0%）；HRadj 2.98，95%CI 1.46-6.09]。这种差异在指数手术后 30 天内出现，且主要由风湿性 MS 患者的差异引起[心血管死亡：7（10.6%）比 24（3.2%）；HRadj 4.80，95%CI 1.98-11.6；致残性卒中：4（6.1%）比 16（2.0%）；HRadj 4.18，95%CI 1.34-13.0]。
在因严重症状性 AS 而接受 TAVR 的患者中，约五分之一的患者同时存在 MS，1 年后心血管不良事件的风险增加 3 倍。这种差异很早就出现了，主要是由风湿性 MS 患者引起的。
