Quebec Heart & Lung Institute, Laval University, Quebec City, Quebec, Canada.
Assistance publique-Hôpitaux de Paris, Bichat Hospital, Paris, France.
Int J Cardiol. 2019 Jul 1;286:36-42. doi: 10.1016/j.ijcard.2019.03.053. Epub 2019 Mar 28.
In patients with severe aortic stenosis (AS) undergoing transcatheter aortic valve replacement (TAVR), the impact of concomitant mitral stenosis (MS) remains unknown. The aim of this study was to determine the incidence and impact of moderate to severe MS in patients undergoing TAVR.
The study included 2113 consecutive patients (mean age: 80 ± 9 years, mean STS: 6.4 ± 5.2%) who underwent TAVR in 2 centers. The presence of MS was defined as a mean transmitral gradient ≥ 5 mm Hg on baseline echocardiography in the absence of severe mitral regurgitation. Clinical events were prospectively collected in a dedicated TAVR database.
A total of 157 patients (7.4%) had moderate to severe MS (mean gradient: 7.2 ± 2.8 mm Hg; degenerative origin in 88%). Patients with MS were younger, more frequently women, had a higher left ventricular ejection fraction and an increased rate of severe pulmonary hypertension (p < 0.02 for all). Thirty-day mortality was similar in both groups (MS: 3.8%; no MS: 5.5%, adjusted p = 0.34). At a mean follow-up of 3 ± 2 years, there were no differences between groups in mortality (MS: 35%, no MS: 36.2%, adjusted HR: 1.14, 95% CI: 0.86-1.51), or heart failure rehospitalization (MS: 21%, no MS: 21.7%; adjusted HR: 1.16, 95% CI: 0.81-1.67). Patients with MS exhibited a similar functional status at follow-up compared to those with no MS (NYHA I-II in 85% and 88% of patients, respectively, adjusted p = 0.20).
About 7% of patients undergoing TAVR had concomitant moderate to severe MS. The presence of MS had no negative impact on early and mid-term clinical outcomes post-TAVR. These results suggest that TAVR is a valid alternative for treating patients with aortic stenosis in the presence of moderate to severe MS.
在接受经导管主动脉瓣置换术（TAVR）治疗的严重主动脉瓣狭窄（AS）患者中，合并二尖瓣狭窄（MS）的影响尚不清楚。本研究旨在确定 TAVR 治疗患者中中度至重度 MS 的发生率和影响。
这项研究纳入了在 2 家中心接受 TAVR 治疗的 2113 例连续患者（平均年龄：80±9 岁，平均 STS：6.4±5.2%）。基线超声心动图上存在平均跨二尖瓣梯度≥5mmHg 且不存在严重二尖瓣反流时定义为 MS。临床事件在专用 TAVR 数据库中进行前瞻性收集。
共有 157 例（7.4%）患者存在中重度 MS（平均梯度：7.2±2.8mmHg；退行性起源占 88%）。MS 组患者更年轻，更多为女性，左心室射血分数更高，且重度肺动脉高压发生率更高（所有指标均为 p<0.02）。两组患者的 30 天死亡率相似（MS：3.8%；无 MS：5.5%，调整后 p=0.34）。在平均 3±2 年的随访中，两组患者死亡率无差异（MS：35%；无 MS：36.2%，调整后 HR：1.14，95%CI：0.86-1.51），或心力衰竭再入院（MS：21%；无 MS：21.7%；调整后 HR：1.16，95%CI：0.81-1.67）。与无 MS 组相比，MS 组患者在随访时的功能状态相似（NYHA I-II 级患者分别占 85%和 88%，调整后 p=0.20）。
约 7%接受 TAVR 的患者存在中度至重度 MS。MS 的存在对 TAVR 后早期和中期临床结局没有负面影响。这些结果表明，TAVR 是治疗中重度 MS 合并主动脉瓣狭窄患者的有效替代方法。
