Jin Qinchun, Li Wei, Chen Shasha, Li Mingfei, Zhou Daxin, Zhang Xiaochun, Ge Junbo
Department of Cardiology, Zhongshan Hospital, Shanghai Institute of Cardiovascular Diseases, Fudan University, Shanghai, China.
National Clinical Research Center for Interventional Medicine, Shanghai, China.
Front Physiol. 2023 Jan 6;13:1088681. doi: 10.3389/fphys.2022.1088681. eCollection 2022.
The study aimed to compare paravalvular leak (PVL) changes after a transcatheter aortic valve replacement (TAVR) with self-expandable prosthesis between different aortic valve morphologies and evaluate the impact of paravalvular leak regression on clinical prognosis. Patients with aortic stenosis (AS) successfully treated with a self-expandable TAVR who were followed up for at least 1 year at our centre were consecutively enrolled from January 2016 to August 2019. Paired serial changes in paravalvular leak and other haemodynamic parameters by echocardiography were collected and compared between the bicuspid valve (BAV) and tricuspid aortic valve (TAV). A logistic regression model was used to explore the predictors of paravalvular leak regression (<1 grade) 1 year after transcatheter aortic valve replacement, while its impact on subsequent clinical outcomes (all-cause mortality and rehospitalisation for heart failure (HF)) was further evaluated using Kaplan-Meier analysis. A total of 153 bicuspid valve and 114 tricuspid aortic valve patients were finally enrolled; haemodynamic parameters and paravalvular leak severity were comparable before the discharge between the two groups. The peak transaortic velocity, mean transvalvular gradient, and effective orifice area all significantly improved ( < 0.05) without intergroup differences at all follow-up timepoints. Significant paravalvular leak reduction was observed only in the TAV group (1.75% 4.39%, = 0.029), while moderate paravalular leak was still more prevalent in BAV (7.19% 1.75%, = 0.041) at the 1-year follow-up. Multivariable analyses identified the bicuspid valve, asymmetric calcification, and undersizing as independent predictors of failure of the 1-year paravalvular leak reduction in patients with mild or moderate paravalvular leak after discharge. Patients without a paravalvular leak reduction within 1 year showed a relatively higher 2-year all-cause mortality and HF (HR: 5.994, 95% CI: 1.691-21.240, and = 0.053) rates thereafter. In AS patients after self-expandable transcatheter aortic valve replacement, paravalvular leak regression within 1 year was less prevalent in bicuspid valve morphology. The failure of paravalvular leak reduction might lead to an increased risk of poorer prognosis in the long run.
本研究旨在比较经导管主动脉瓣置换术（TAVR）使用自膨胀式假体后不同主动脉瓣形态的瓣周漏（PVL）变化，并评估瓣周漏消退对临床预后的影响。2016年1月至2019年8月，连续纳入在本中心接受自膨胀式TAVR成功治疗且随访至少1年的主动脉瓣狭窄（AS）患者。通过超声心动图收集并比较二尖瓣（BAV）和三尖瓣主动脉瓣（TAV）的瓣周漏及其他血流动力学参数的配对系列变化。使用逻辑回归模型探索经导管主动脉瓣置换术后1年瓣周漏消退（<1级）的预测因素，同时使用Kaplan-Meier分析进一步评估其对后续临床结局（全因死亡率和心力衰竭（HF）再住院）的影响。最终共纳入153例二尖瓣患者和114例三尖瓣主动脉瓣患者；两组出院前的血流动力学参数和瓣周漏严重程度具有可比性。在所有随访时间点，跨主动脉峰值流速、平均跨瓣压差和有效瓣口面积均显著改善（<0.05），且组间无差异。仅在TAV组观察到瓣周漏显著减少（1.75%对4.39%，P = 0.029），而在1年随访时，中度瓣周漏在BAV中仍更常见（7.19%对1.75%，P = 0.041）。多变量分析确定二尖瓣、不对称钙化和尺寸过小是出院后轻度或中度瓣周漏患者1年瓣周漏减少失败的独立预测因素。1年内未出现瓣周漏减少的患者此后2年全因死亡率和HF发生率相对较高（HR：5.994，95%CI：1.691 - 21.240，P = 0.053）。在接受自膨胀式经导管主动脉瓣置换术的AS患者中，二尖瓣形态在1年内瓣周漏消退较少见。瓣周漏减少失败可能会导致长期预后较差风险增加。
