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经导管主动脉瓣置换术患者的长期预后和瓣膜性能。

Long-Term Outcomes and Valve Performance in Patients Undergoing Transcatheter Aortic Valve Implantation.

机构信息

Department of Cardiology, Medical School of Athens University, Hippokration Hospital, Athens, Greece.

Department of Cardiology, Onassis Heart Center, Athens, Greece.

出版信息

Am J Cardiol. 2021 May 15;147:80-87. doi: 10.1016/j.amjcard.2021.02.006. Epub 2021 Feb 20.


DOI:10.1016/j.amjcard.2021.02.006
PMID:33621524
Abstract

Transcatheter aortic valve implantation (TAVI) is an established method for treating patients with aortic valve stenosis. We sought to determine the long-term clinical outcomes and performance of a self-expanding bioprosthesis beyond 5 years. Consecutive patients scheduled for TAVI were included in the analysis. Primary end points were all-cause and cardiovascular mortality, structural valve deterioration (SVD) and bioprosthetic valve failure (BVF), based on the VARC-2 criteria and consensus statement by ESC/EAPCI. The study prospectively evaluated 273 patients (80.61 ± 7.00 years old, 47% females) who underwent TAVI with CoreValve/Evolut-R (Medtronic Inc.). The median follow-up duration was 5 years (interquartile range: 2.9 to 6; longest: 8 years). At 1, 5, and 8 years, estimated survival rates were 89.0%, 61.1%, and 56.0%, respectively, while cardiovascular mortality was 8% at the end of follow-up. Regarding valve performance, 5% of patients had early BVF and 1% had late BVF. Concerning SVD, 16 patients (6% of the total population) had moderate SVD (91% had an increase in mean gradient), with no severe SVD cases. Five patients with SVD died during follow-up. Actual analysis of the 8-year cumulative incidence of function of moderate SVD was 5.9% (2.5% to 16.2%). At multivariate analysis, the factor that emerged as an independent predictor for future SVD, was smaller bioprosthetic valve size (HR 0.58, 95% CI 0.41 to 0.82, p = 0.002). Long-term evaluation beyond 5 years after TAVI with a self-expanding bioprosthesis demonstrated low rates of cardiovascular mortality and structural valve deterioration. Valve size was an independent predictor for SVD.

摘要

经导管主动脉瓣植入术(TAVI)是治疗主动脉瓣狭窄患者的一种成熟方法。我们旨在确定自膨式生物瓣在 5 年以上的长期临床结局和性能。连续接受 TAVI 的患者被纳入分析。主要终点是根据 VARC-2 标准和 ESC/EAPCI 共识声明,全因和心血管死亡率、结构性瓣膜退化(SVD)和生物瓣故障(BVF)。该研究前瞻性评估了 273 名(80.61 ± 7.00 岁,47%为女性)接受 CoreValve/Evolut-R(美敦力公司)TAVI 的患者。中位随访时间为 5 年(四分位距:2.9 至 6;最长:8 年)。在 1、5 和 8 年时,估计生存率分别为 89.0%、61.1%和 56.0%,而在随访结束时心血管死亡率为 8%。关于瓣膜性能,5%的患者发生早期 BVF,1%的患者发生晚期 BVF。关于 SVD,16 名患者(占总人数的 6%)有中度 SVD(91%的平均梯度增加),没有严重 SVD 病例。5 名 SVD 患者在随访期间死亡。对 SVD 中度功能的 8 年累积发生率的实际分析为 5.9%(2.5%至 16.2%)。多变量分析显示,生物瓣尺寸较小是未来发生 SVD 的独立预测因素(HR 0.58,95%CI 0.41 至 0.82,p = 0.002)。TAVI 后 5 年以上的长期评估显示,心血管死亡率和结构性瓣膜退化的发生率较低。瓣膜尺寸是 SVD 的独立预测因素。

相似文献

[1]
Long-Term Outcomes and Valve Performance in Patients Undergoing Transcatheter Aortic Valve Implantation.

Am J Cardiol. 2021-5-15

[2]
Evaluation of structural valve deterioration and bioprosthetic valve failure utilizing the new European consensus definition in patients undergoing TAVI with first-generation devices: Outcomes beyond 5 years from a single center in Turkey.

Anatol J Cardiol. 2021-8

[3]
Assessment of Long-Term Structural Deterioration of Transcatheter Aortic Bioprosthetic Valves Using the New European Definition.

Circ Cardiovasc Interv. 2019-4

[4]
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Eur Heart J. 2024-4-1

[5]
Ten year follow-up of high-risk patients treated during the early experience with transcatheter aortic valve replacement.

Catheter Cardiovasc Interv. 2021-2-15

[6]
Long-term clinical outcome and performance of transcatheter aortic valve replacement with a self-expandable bioprosthesis.

Eur Heart J. 2020-5-21

[7]
Long-Term Echocardiographic Follow-Up After Transcatheter Aortic Valve Implantation to Assess Structural Valve Deterioration and Bioprosthetic Valve Failure.

Heart Lung Circ. 2022-4

[8]
Long-Term Outcomes Following Surgical Aortic Bioprosthesis Implantation.

J Am Coll Cardiol. 2018-4-3

[9]
Structural Valve Deterioration After Self-Expanding Transcatheter or Surgical Aortic Valve Implantation in Patients at Intermediate or High Risk.

JAMA Cardiol. 2023-2-1

[10]
Long-Term Durability of Transcatheter Aortic Valve Implantation With Self-Expandable Valve System (from a Real-World Registry).

Am J Cardiol. 2021-3-15

引用本文的文献

[1]
Bicuspid Aortic Valve Disease: From Pathophysiology to Treatment.

J Clin Med. 2024-8-23

[2]
Emerging Transcatheter Therapies for Valvular Heart Disease: Focus on Mitral and Tricuspid Valve Procedures.

Life (Basel). 2024-7-2

[3]
Transcatheter Aortic Valve Implantation: What has Happened and What is Yet to Come.

Arq Bras Cardiol. 2023-7

[4]
The Role of ECG Strain Pattern in Prognosis after TAVI: A Sub-Analysis of the DIRECT Trial.

Life (Basel). 2023-5-24

[5]
Technical Aspects and Development of Transcatheter Aortic Valve Implantation.

J Cardiovasc Dev Dis. 2022-8-22

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