Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania.
Heart and Vascular Institute, University of Pittsburgh Medical Center Pittsburgh, Pennsylvania.
Ann Thorac Surg. 2023 Oct;116(4):728-734. doi: 10.1016/j.athoracsur.2023.02.008. Epub 2023 Feb 14.
This study sought to evaluate outcomes of transcatheter aortic valve replacement (TAVR) in patients with moderate or greater aortic regurgitation (AR).
This was an observational study using an institutional database of TAVRs from November 2012 to April 2022. The study compared outcomes of TAVR in patients with isolated aortic stenosis (AS) vs patients with AS and concomitant AR (moderate or greater). Those patients with trace or mild AR were excluded. Clinical and echocardiographic outcomes were compared, with end points established by the Valve Academic Research Consortium 3. Kaplan-Meier survival estimation and Cox regression for mortality were performed. Competing-risk cumulative incidence estimates for heart failure readmissions were also compared.
Of 3295 patients, 605 (53.4%) had severe AS with no AR and 529 (46.6%) had severe AS with moderate or severe AR. There were no significant differences in in-hospital mortality, length of stay, stroke, myocardial infarction, permanent pacemaker requirement, transfusion requirement, minor or major vascular complications, or 30-day readmissions between the 2 groups (P > .05). There were also no significant differences in annular dissection or rupture, coronary obstruction, or device embolization. Mean gradient and paravalvular leak rates at 30 days and 1 year were similar between the groups. Survival estimates were comparable, and, on multivariable Cox regression, mixed aortic valvular disease was not associated with an increased hazard of death as compared with isolated AS (hazard ratio, 1.01; 95% CI, 0.81-1.25; P = .962). Cumulative incidence estimates for heart failure readmissions were comparable between groups.
TAVR can be safely performed in patients with mixed valvular disease, with outcomes comparable to those in isolated AS.
本研究旨在评估中重度主动脉瓣反流（AR）患者行经导管主动脉瓣置换术（TAVR）的结局。
这是一项使用 2012 年 11 月至 2022 年 4 月 TAVR 机构数据库的观察性研究。该研究比较了单纯主动脉瓣狭窄（AS）患者与同时患有 AS 和伴发 AR（中重度）患者的 TAVR 结局。排除了 AR 为微量或轻度的患者。比较了临床和超声心动图结局，终点由瓣膜学术研究联合会 3 确定。进行 Kaplan-Meier 生存估计和 Cox 回归分析死亡率。还比较了心力衰竭再入院的竞争风险累积发病率估计。
在 3295 例患者中，605 例（53.4%）为无 AR 的重度 AS，529 例（46.6%）为有中重度 AR 的重度 AS。两组间住院死亡率、住院时间、卒中和心肌梗死、永久性起搏器需求、输血需求、小血管或大血管并发症或 30 天再入院率无显著差异（P >.05）。两组间也无环形夹层或破裂、冠状动脉阻塞或器械栓塞的显著差异。两组间 30 天和 1 年时平均跨瓣压差和瓣周漏率相似。生存估计相似，多变量 Cox 回归分析显示，混合性主动脉瓣疾病与孤立性 AS 相比，死亡风险无显著增加（危险比，1.01；95%CI，0.81-1.25；P =.962）。两组心力衰竭再入院的累积发病率估计相似。
TAVR 可安全应用于混合瓣膜疾病患者，结局与孤立性 AS 患者相似。
