Chiche Olivier, Rodés-Cabau Josep, Campelo-Parada Francisco, Freitas-Ferraz Afonso B, Regueiro Ander, Chamandi Chekrallah, Rodriguez-Gabella Tania, Côté Mélanie, DeLarochellière Robert, Paradis Jean-Michel, Dumont Eric, Doyle Daniel, Mohammadi Siamak, Bergeron Sébastien, Pibarot Philippe, Beaudoin Jonathan
Institut Universitaire de Cardiologie et de Pneumologie de Québec - Université Laval, Québec City, Québec, Canada.
Centre Hospitalier Universitaire de Nice - Département de Cardiologie, Nice, France.
Echocardiography. 2019 Apr;36(4):722-731. doi: 10.1111/echo.14303. Epub 2019 Mar 4.
Significant mitral regurgitation (MR) is associated with poorer outcomes in patients undergoing transcatheter aortic valve replacement (TAVR). Factors associated with MR improvement have not been studied thoroughly.
Retrospective analysis of consecutive patients treated with TAVR with more than mild MR at baseline. MR evolution was assessed at 1-3 and 6-12 months after intervention. MR severity and mechanisms were assessed by echocardiography. Mitral annulus calcification (MAC) was quantified using preoperative cardiac CT.
From 674 consecutive TAVR recipients, 78 with more than mild MR had a 6-12 months follow-up. Following TAVR, MR improved in 34 patients (43%), remained stable in 38 (49%) and worsened in 6 (8%). Patients with MR improvement had greater tenting area (141 ± 56 vs. 99 ± 40 mm , P < 0.01), tenting height (7.2 ± 1.9 vs. 5.6 ± 1.9 mm, P < 0.01) and lower ejection fraction (43 ± 16 vs. 52 ± 14%, P = 0.01). MAC was frequent (87.7% of patients) and a trend in greater MAC was observed in patients without MR improvement (3560 ± 5587 vs. 2053 ± 2800, P = 0.16). In multivariable analysis, tenting area (OR per 10 mm increase: 1.012, 95% CI, 1.001-1.024 P = 0.039) and annulus calcifications associated with leaflet restriction (OR = 0.108, 95% CI, 0.012-0.956, P = 0.045) were independently associated with MR outcome after TAVR.
Larger mitral valve tenting area was associated with more improvement of MR after TAVR whereas extensive MAC associated with leaflet restriction was associated with less improvement. This may help in the clinical decision-making process of TAVR candidates with concomitant MR.
严重二尖瓣反流（MR）与经导管主动脉瓣置换术（TAVR）患者的预后较差相关。与MR改善相关的因素尚未得到充分研究。
对基线时存在中重度以上MR且接受TAVR治疗的连续患者进行回顾性分析。在干预后1 - 3个月和6 - 12个月评估MR的演变情况。通过超声心动图评估MR的严重程度和机制。使用术前心脏CT对二尖瓣环钙化（MAC）进行定量分析。
在674例连续接受TAVR治疗的患者中，78例中重度以上MR患者进行了6 - 12个月的随访。TAVR术后，34例患者（43%）的MR有所改善，38例（49%）保持稳定，6例（8%）恶化。MR改善的患者有更大的瓣叶撑开面积（141±56 vs. 99±40mm²，P < 0.01）、瓣叶撑开高度（7.2±1.9 vs. 5.6±1.9mm，P < 0.01）和更低的射血分数（43±16 vs. 52±14%，P = 0.01）。MAC很常见（87.7%的患者），在MR未改善的患者中观察到MAC有增加的趋势（3560±5587 vs. 2053±2800，P = 0.16）。在多变量分析中，瓣叶撑开面积（每增加10mm²的OR值：1.012，95%CI，1.001 - 1.024，P = 0.039）和与瓣叶受限相关的瓣环钙化（OR = 0.108，95%CI，0.012 - 0.956，P = 0.045）与TAVR术后的MR结局独立相关。
更大的二尖瓣瓣叶撑开面积与TAVR术后MR的更多改善相关，而与瓣叶受限相关的广泛MAC与较少的改善相关。这可能有助于伴有MR的TAVR候选患者的临床决策过程。
