Department of Cardiology, Swiss Cardiovascular Center, Bern University Hospital, Freibrugstrasse, 3010, Bern, Switzerland.
Institute of Social and Preventive Medicine and Clinical Trials Unit, University of Bern, Mittelstrasse 43, 3012, Bern, Switzerland.
Clin Res Cardiol. 2019 Dec;108(12):1343-1353. doi: 10.1007/s00392-019-01469-z. Epub 2019 Mar 30.
The impact of aortic valvular resistance (VR) on the degree of post-transcatheter aortic valve replacement (TAVR) aortic regurgitation (AR) remains unclear. The objective of the study was to investigate the relationship between VR and paravalvular AR after TAVR.
Between August 2007 and December 2015, 708 TAVR patients had sufficient data to calculate VR before the intervention and were eligible for the present analysis. The patient population was dichotomized according to VR. The association between VR and post-TAVR AR was separately assessed by prosthesis type.
Among patients with low VR (LVR; < 238 dynes/cm), 176 (49.7%) patients were treated with balloon-expandable (BE) valves and 178 (51.3%) patients with self-expandable (SE) transcatheter valves. Among patients with high VR (HVR ≥ 238), 147 (41.5%) and 207 (68.5%) patients received BE and SE, respectively. Baseline characteristics were similar in both groups irrespective of the type of valve. Patients with HVR had a 2.5-fold risk of ≥ moderate post-TAVR AR compared to patients with LVR. Both, HVR (HR 2.45, 95% CI 1.33-4.51) and the use of SE (HR 3.11, 95% CI 1.66-5.82), emerged as independent predictors of ≥ moderate post-TAVR AR. Moderate or greater post-AR was consistently predicted in patients treated with SE (HR 2.42, 95% CI 1.22-4.80) irrespective of the level of VR.
HVR is associated with a nearly 2.5-fold increased risk of moderate or greater post-TAVR AR and is an independent predictor of post-TAVR AR.
主动脉瓣阻力（VR）对经导管主动脉瓣置换（TAVR）后主动脉瓣反流（AR）程度的影响尚不清楚。本研究旨在探讨 TAVR 后 VR 与瓣周 AR 的关系。
2007 年 8 月至 2015 年 12 月，708 例 TAVR 患者有足够数据在干预前计算 VR，符合本分析条件。根据 VR 将患者人群分为两组。分别评估不同假体类型下 VR 与 TAVR 后 AR 的相关性。
在 VR 较低（LVR； < 238 dynes/cm）的患者中，176 例（49.7%）接受球囊扩张（BE）瓣膜治疗，178 例（51.3%）接受自膨式（SE）经导管瓣膜治疗。在 VR 较高（HVR ≥ 238）的患者中，分别有 147 例（41.5%）和 207 例（68.5%）接受 BE 和 SE。两组患者的基线特征在瓣膜类型方面无显著差异。与 LVR 患者相比，HVR 患者发生 ≥ 中度 TAVR AR 的风险增加了 2.5 倍。HVR（HR 2.45，95%CI 1.33-4.51）和 SE 的使用（HR 3.11，95%CI 1.66-5.82）均为 ≥ 中度 TAVR AR 的独立预测因素。无论 VR 水平如何，SE 治疗的患者均一致预测出中度或更严重的 AR（HR 2.42，95%CI 1.22-4.80）。
HVR 与中度或更严重的 TAVR 后 AR 的风险增加近 2.5 倍有关，是 TAVR 后 AR 的独立预测因素。
