Department of Medicine, Cleveland Clinic, Cleveland, Ohio.
Department of Cardiovascular Medicine, Aortic Valve Center, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio.
JACC Cardiovasc Interv. 2019 Nov 25;12(22):2299-2306. doi: 10.1016/j.jcin.2019.06.020. Epub 2019 Oct 30.
The aim of this study was to compare outcomes after transcatheter aortic valve replacement (TAVR) in patients with pure aortic stenosis (AS) (i.e., no or trivial associated aortic regurgitation [AR]) with those in patients with AS and mild or more severe AR (i.e., mixed aortic valve disease [MAVD]).
TAVR is indicated in treating patients with severe AS. Limited data exist regarding the outcomes of TAVR in patients with MAVD.
A total of 1,133 patients who underwent TAVR between January 2014 and December 2017 were included. The primary outcome was all-cause mortality. The comparison was adjusted to account for post-TAVR AR development in both groups. The secondary outcomes included composite endpoints of early safety and clinical efficacy as specified in the Valve Academic Research Consortium-2 criteria. Variables were compared using Mann-Whitney, chi-square, and Fisher exact tests, while Kaplan-Meier analyses were used to compare survival.
A total of 688 patients (61%) had MAVD (median age 83 years , 43% women). Among these, 17% developed mild, 2% moderate, and <1% severe post-TAVR AR. Overall, patients with MAVD had better survival compared with patients with pure AS (p = 0.03). Among patients who developed post-TAVR AR, those in the MAVD group had better survival (p = 0.04). In contrast, in patients who did not develop post-TAVR AR, pre-TAVR AR did not improve survival (p = 0.11).
Patients with MAVD who underwent TAVR had better survival compared with patients with pure AS. This is explained by the better survival of patients with MAVD who developed post-TAVR AR, likely due to left ventricular adaptation to AR.
本研究旨在比较单纯主动脉瓣狭窄（AS）（即无或轻度相关主动脉瓣反流[AR]）患者与 AS 合并轻度或更重度 AR（即混合性主动脉瓣疾病[MAVD]）患者行经导管主动脉瓣置换术（TAVR）后的结局。
TAVR 适用于治疗重度 AS 患者。关于 MAVD 患者 TAVR 结局的数据有限。
共纳入 2014 年 1 月至 2017 年 12 月期间接受 TAVR 的 1133 例患者。主要结局为全因死亡率。两组均调整了 TAVR 后 AR 发展情况。次要结局包括 Valve Academic Research Consortium-2 标准规定的早期安全性和临床疗效的复合终点。使用 Mann-Whitney、卡方和 Fisher 精确检验比较变量，Kaplan-Meier 分析比较生存情况。
共 688 例（61%）患者为 MAVD（中位年龄 83 岁，43%为女性）。其中，17%患者发生轻度、2%中度和<1%重度 TAVR 后 AR。总体而言，与单纯 AS 患者相比，MAVD 患者的生存率更好（p=0.03）。在发生 TAVR 后 AR 的患者中，MAVD 组患者的生存率更好（p=0.04）。相比之下，在未发生 TAVR 后 AR 的患者中，TAVR 前 AR 并不能提高生存率（p=0.11）。
接受 TAVR 的 MAVD 患者的生存率优于单纯 AS 患者。这可以解释为 TAVR 后发生 AR 的 MAVD 患者生存率更好，这可能是由于左心室对 AR 的适应性。
