Division of Cardiovascular Medicine, University of Missouri-Columbia School of Medicine, Columbia, MO.
University of Missouri-Kansas City, Kansas City, MO.
Am Heart J. 2020 Oct;228:57-64. doi: 10.1016/j.ahj.2020.07.010. Epub 2020 Jul 17.
Data regarding outcomes for patients with severe aortic stenosis (AS) with concomitant aortic insufficiency (AI), undergoing transcatheter aortic valve replacement (TAVR) are limited. This study aimed to analyze the prevalence of severe AS with concomitant AI among patients undergoing TAVR and outcomes of TAVR in this patient group.
Using data from the STS/ACC-TVT Registry, we identified patients with severe AS with or without concomitant AI who underwent TAVR between 2011 and 2016. Patients were categorized based on the severity of pre-procedural AI. Multivariable proportional hazards regression models were used to examine all-cause mortality and heart failure (HF) hospitalization at 1-year. Among 54,535 patients undergoing TAVR, 42,568 (78.1%) had severe AS with concomitant AI. Device success was lower in patients with severe AS with concomitant AI as compared with isolated AS. The presence of baseline AI was associated with lower 1 year mortality (HR 0.94 per 1 grade increase in AI severity; 95% CI, 0.91-0.98, P < .001) and HF hospitalization (HR 0.87 per 1 grade increase in AI severity; 95% CI, 0.84-0.91, P < .001).
Severe AS with concomitant AI is common among patients undergoing TAVR, and is associated with lower 1 year mortality and HF hospitalization. Future studies are warranted to better understand the mechanisms underlying this benefit.
In this nationally representative analysis from the United States, 78.1% of patients undergoing TAVR had severe AS with concomitant AI. Device success was lower in patients with severe AS with concomitant AI as compared with isolated AS. The presence of baseline AI was associated with lower 1 year mortality (HR 0.94 per 1 grade increase in AI severity; 95% CI, 0.91-0.98, P < .001) and HF hospitalization (HR 0.87 per 1 grade increase in AI severity; 95% CI, 0.84-0.91, P < .001).
关于同时患有严重主动脉瓣狭窄（AS）和主动脉瓣关闭不全（AI）的患者接受经导管主动脉瓣置换术（TAVR）的结局数据十分有限。本研究旨在分析 2011 年至 2016 年间接受 TAVR 的患者中严重 AS 合并 AI 的患病率以及该患者群体中 TAVR 的结局。
利用 STS/ACC-TVT 注册研究的数据，我们确定了 2011 年至 2016 年间接受 TAVR 的严重 AS 合并或不合并 AI 的患者。患者根据术前 AI 的严重程度进行分类。多变量比例风险回归模型用于检查 1 年时的全因死亡率和心力衰竭（HF）住院率。在 54535 例接受 TAVR 的患者中，42568 例（78.1%）患有严重 AS 合并 AI。与单纯 AS 相比，严重 AS 合并 AI 患者的器械成功率较低。基线 AI 的存在与 1 年死亡率降低相关（AI 严重程度每增加 1 级，HR 为 0.94；95%CI，0.91-0.98，P<0.001）和 HF 住院率降低相关（AI 严重程度每增加 1 级，HR 为 0.87；95%CI，0.84-0.91，P<0.001）。
严重 AS 合并 AI 在接受 TAVR 的患者中很常见，且与 1 年死亡率和 HF 住院率降低相关。需要进一步研究以更好地了解这种获益的潜在机制。
