Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, United States of America.
Division of Cardiology, NYU Langone Hospital - Long Island, Mineola, NY, United States of America.
Cardiovasc Revasc Med. 2021 Nov;32:35-40. doi: 10.1016/j.carrev.2020.12.032. Epub 2020 Dec 30.
BACKGROUND/PURPOSE: Several studies have reported that mitral regurgitation (MR) can improve following transcatheter aortic valve replacement (TAVR) alone using earlier-generation valves. The purpose of this study was to determine the predictors and short-term outcome impact of MR in patients undergoing TAVR using all generation valves across all risk groups.
METHODS/MATERIALS: In this retrospective, study from 2012 to 2020, we reviewed data on 1822 low-, intermediate-, and high-risk patients who underwent TAVR. Included were 1266 patients with baseline MR who underwent transfemoral TAVR. Our primary outcome was persistence or worsening of baseline MR post-TAVR. Additional endpoints included an inpatient composite (intensive care unit length of stay >24 h, post-TAVR length of stay >2 days, and inpatient death), 30-day composite (30-day death or readmission), and 1-year composite (1-year death or readmission).
Of the 1266 patients included, 665 had significant baseline MR (≥moderate), which improved in 79.4% of patients (n=528). Female patients, those with lower body mass indices, and those with higher right ventricular systolic pressures were more likely to have persistence or worsening of baseline MR. Patients whose baseline MR persisted or worsened, had higher rates (80.3% vs. 77.3%, p=0.0019) of our inpatient composite, higher rates (15.3% vs. 10.0%, p=0.0389) of our 30-day composite, and higher rates (36.7% vs. 26.8%, p=0.0107) of our 1-year composite when compared to patients whose baseline MR improved post-TAVR.
Our study identifies clinical characteristics, which help identify patients who may require closer post-procedural follow-up and warrant possible staged mitral valve intervention post-TAVR across all risk groups.
背景/目的：多项研究报告称，使用早期一代瓣膜，单纯经导管主动脉瓣置换术（TAVR）后可改善二尖瓣反流（MR）。本研究的目的是确定所有风险组患者接受所有代瓣膜 TAVR 后 MR 的预测因素及其对短期结果的影响。
方法/材料：在这项回顾性研究中，纳入了 2012 年至 2020 年间接受 TAVR 的 1822 例低、中、高危患者的数据。包括 1266 例基线有 MR 的患者，这些患者接受了经股 TAVR。我们的主要结局是 TAVR 后基线 MR 的持续或加重。其他终点包括住院复合终点（重症监护病房住院时间>24 小时、TAVR 后住院时间>2 天和住院死亡）、30 天复合终点（30 天死亡或再入院）和 1 年复合终点（1 年死亡或再入院）。
在纳入的 1266 例患者中，665 例基线有明显的 MR（≥中度），其中 79.4%（n=528）的患者 MR 得到改善。女性患者、身体质量指数较低的患者和右心室收缩压较高的患者更有可能出现基线 MR 的持续或加重。基线 MR 持续或加重的患者，住院复合终点发生率更高（80.3% vs. 77.3%，p=0.0019），30 天复合终点发生率更高（15.3% vs. 10.0%，p=0.0389），1 年复合终点发生率更高（36.7% vs. 26.8%，p=0.0107），与 TAVR 后基线 MR 改善的患者相比。
本研究确定了有助于识别可能需要更密切的术后随访的患者的临床特征，并为所有风险组患者 TAVR 后可能需要分期二尖瓣干预提供依据。
