Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, United States of America.
Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, United States of America.
Int J Cardiol. 2020 Jan 15;299:209-214. doi: 10.1016/j.ijcard.2019.07.099. Epub 2019 Aug 1.
MAVD, defined as severe aortic stenosis with moderate or severe aortic regurgitation, is frequently encountered in clinical practice. However, the data regarding TAVR outcomes in MAVD are sparse. We compared Transcatheter Aortic Valve Replacement (TAVR) outcomes between Mixed Aortic Valve Disease (MAVD) and Predominant Aortic Stenosis (PAS) patients.
Patients who underwent TAVR at Mayo Clinic from February 7, 2012 to December 16, 2016 were enrolled. The primary end point was all-cause mortality. Secondary end points were central or paravalvular regurgitation, device success, and Valve Academic Research Consortium (VARC)-2 defined post TAVR complications (access site complications, bleedings, myocardial infarction, stroke, and cardiac arrest).
A total of 622 patients were enrolled. Mean age was 81 ± 8.9 years, and 263 (42.3%) were female. Median follow-up duration was 1.5 years. One hundred and sixteen patients (18.6%) had MAVD. Central or paravalvular leak was higher in MAVD patients post-TAVR (15.5% vs 6.7%, P = 0.004). Device success and VARC-2 in-hospital complications were similar between the two groups. The cumulative probability of survival at 3 years was 71.3% in MAVD patients vs. 62.6% in PAS patients (Log-Rank P = 0.024). In a multi-variant logistic regression analysis, MAVD was an independent negative predictor of all-cause mortality (HR = 0.53, 95% CI 0.3-0.89, P = 0.015).
A significant number of patients referred for TAVR have MAVD disease. Despite higher rates of paravalvular regurgitation, all-cause mortality at mid-term was lower in patients with MAVD compared with those with PAS. Our results show the safety and efficacy of TAVR in MAVD patients.
MAVD 定义为严重主动脉瓣狭窄合并中度或重度主动脉瓣反流，在临床实践中经常遇到。然而，关于 MAVD 经导管主动脉瓣置换术（TAVR）结果的数据很少。我们比较了混合性主动脉瓣疾病（MAVD）和主要主动脉瓣狭窄（PAS）患者的 TAVR 结果。
入选 2012 年 2 月 7 日至 2016 年 12 月 16 日在梅奥诊所接受 TAVR 的患者。主要终点是全因死亡率。次要终点为中心或瓣周反流、器械成功率和 Valve Academic Research Consortium（VARC）-2 定义的 TAVR 后并发症（入路并发症、出血、心肌梗死、卒中和心脏骤停）。
共纳入 622 例患者。平均年龄为 81±8.9 岁，263 例（42.3%）为女性。中位随访时间为 1.5 年。116 例（18.6%）患者患有 MAVD。MAVD 患者 TAVR 后中心或瓣周漏发生率较高（15.5%比 6.7%，P=0.004）。两组器械成功率和 VARC-2 院内并发症相似。MAVD 患者 3 年累积生存率为 71.3%，PAS 患者为 62.6%（Log-Rank P=0.024）。多变量逻辑回归分析显示，MAVD 是全因死亡率的独立负预测因素（HR=0.53，95%CI 0.3-0.89，P=0.015）。
大量接受 TAVR 治疗的患者患有 MAVD 疾病。尽管瓣周反流发生率较高，但与 PAS 患者相比，MAVD 患者的中期全因死亡率较低。我们的结果表明 TAVR 在 MAVD 患者中的安全性和有效性。
