Laakso Teemu, Laine Mika, Moriyama Noriaki, Dahlbacka Sebastian, Airaksinen Juhani, Virtanen Marko, Husso Annastiina, Tauriainen Tuomas, Niemelä Matti, Mäkikallio Timo, Valtola Antti, Eskola Markku, Juvonen Tatu, Biancari Fausto, Raivio Peter
Heart and Lung Center, Helsinki University Hospital, Helsinki, Finland.
Heart Center, Turku University Hospital, Turku, Finland.
Eur J Cardiothorac Surg. 2020 Dec 1;58(6):1145-1152. doi: 10.1093/ejcts/ezaa254.
The aim of this study was to evaluate the incidence and prognostic impact of paravalvular regurgitation (PVR) on the outcome after transcatheter (TAVR) and surgical aortic valve replacement (SAVR) for aortic stenosis.
The nationwide FinnValve registry included data on 6463 consecutive patients who underwent TAVR (n = 2130) or SAVR (n = 4333) with a bioprosthesis for the treatment of aortic stenosis during 2008-2017. The impact of PVR at discharge after TAVR and SAVR on 4-year mortality was herein investigated.
The rate of mild PVR was 21.7% after TAVR and 5.2% after SAVR. The rate of moderate-to-severe PVR was 3.7% after TAVR and 0.7% after SAVR. After TAVR, 4-year survival was 69.0% in patients with none-to-trace PVR, 54.2% with mild PVR [adjusted hazard ratio (HR) 1.64, 95% confidence interval (CI) 1.35-1.99] and 48.9% with moderate-to-severe PVR (adjusted HR 1.61, 95% CI 1.10-2.35). Freedom from PVR-related reinterventions was 100% for none-to-mild PVR and 95.2% for moderate-to-severe PVR. After SAVR, mild PVR (4-year survival 78.9%; adjusted HR 1.29, 95% CI 0.93-1.78) and moderate-to-severe PVR (4-year survival 67.8%; adjusted HR 1.36, 95% CI 0.72-2.58) were associated with worse 4-year survival compared to none-to-trace PVR (4-year survival 83.7%), but the difference did not reach statistical significance in multivariable analysis. Freedom from PVR-related reinterventions was 99.5% for none-to-trace PVR patients, 97.9% for mild PVR patients and 77.0% for moderate-to-severe PVR patients.
This multicentre study showed that both mild and moderate-to-severe PVR were independent predictors of worse survival after TAVR. Mild and moderate-to-severe PVR are not frequent after SAVR, but tend to decrease survival also in these patients.
ClinicalTrials.gov Identifier: NCT03385915.
本研究旨在评估经导管主动脉瓣置换术（TAVR）和外科主动脉瓣置换术（SAVR）治疗主动脉瓣狭窄后瓣周反流（PVR）的发生率及其对预后的影响。
全国性的FinnValve注册研究纳入了2008年至2017年间连续6463例行TAVR（n = 2130）或SAVR（n = 4333）并使用生物瓣膜治疗主动脉瓣狭窄患者的数据。本文研究了TAVR和SAVR术后出院时PVR对4年死亡率的影响。
TAVR术后轻度PVR发生率为21.7%，SAVR术后为5.2%。TAVR术后中重度PVR发生率为3.7%，SAVR术后为0.7%。TAVR术后，无至微量PVR患者的4年生存率为69.0%，轻度PVR患者为54.2%[调整后风险比（HR）1.64，95%置信区间（CI）1.35 - 1.99]，中重度PVR患者为48.9%（调整后HR 1.61，95%CI 1.10 - 2.35）。无至轻度PVR患者无PVR相关再次干预的比例为100%，中重度PVR患者为95.2%。SAVR术后，与无至微量PVR患者（4年生存率83.7%）相比，轻度PVR（4年生存率78.9%；调整后HR 1.29，95%CI 0.93 - 1.78）和中重度PVR（4年生存率67.8%；调整后HR 1.36，95%CI 0.72 - 2.58）与4年生存率较差相关，但在多变量分析中差异未达到统计学意义。无至微量PVR患者无PVR相关再次干预的比例为99.5%，轻度PVR患者为97.9%，中重度PVR患者为77.0%。
这项多中心研究表明，轻度和中重度PVR都是TAVR术后生存率较差的独立预测因素。SAVR术后轻度和中重度PVR并不常见，但这些患者的生存率也往往会降低。
ClinicalTrials.gov标识符：NCT03385915
