Demirel Caglayan, Winter Max Paul, Nitsche Christian, Koschatko Sophia, Jantsch Charlotte, Mascherbauer Katharina, Halavina Kseniya, Heitzinger Gregor, Dona Carolina, Dannenberg Varius, Spinka Georg, Koschutnik Matthias, Andreas Martin, Hengstenberg Christian, Bartko Philipp E
Department of Internal Medicine II, Clinical Division of Cardiology, Medical University of Vienna, Waehringer Guertel 18-20A, 1090 Vienna, Austria.
Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria.
Eur Heart J Cardiovasc Imaging. 2024 Apr 30;25(5):718-726. doi: 10.1093/ehjci/jeae005.
Transcatheter aortic valve replacement (TAVR) revolutionized the therapy of severe aortic stenosis (AS) with rising numbers. Mixed aortic valve disease (MAVD) treated by TAVR is gaining more interest, as those patients represent a more complex cohort as compared with isolated AS. However, concerning long-term outcome for this cohort only, limited data are available. The aim of the study is to assess the prevalence of MAVD in TAVR patients, investigate its association with paravalvular regurgitation (PVR), and analyse its impact on long-term mortality after TAVR.
We conducted a registry-based cohort study using the Vienna TAVR registry, enrolling patients who underwent TAVR at Medical University of Vienna between January 2007 and May 2020 with available transthoracic echocardiography before and after TAVR (n = 880). Data analysis included PVR incidence and long-term survival outcomes. A total of 647 (73.52%) out of 880 patients had ≥ mild aortic regurgitation next to severe AS. MAVD was associated with PVR compared with isolated AS with an odds ratio of 2.06, 95% confidence interval (CI): 1.51-2.81 (P = <0.001). More than mild PVR after TAVR (n = 168 out of 880: 19.09%) was related to higher mortality compared with the absence of PVR with a hazard ratio (HR) of 1.33, 95% CI: 1.05- 1.67 (P = 0.016). MAVD patients developing ≥ mild PVR after TAVR were also associated with higher mortality compared with the absence of PVR with an HR of 1.30 and 95% CI: 1.04-1.62 (P = 0.022).
MAVD is prevalent among TAVR patients and presents unique challenges, with increased PVR risk and worse outcomes compared with isolated AS. Long-term survival for MAVD patients, not limited to those developing PVR post-TAVR, is compromised. Earlier intervention before the occurrence of structural myocardial damage or surgical valve replacement might be a potential workaround to improve outcomes.
经导管主动脉瓣置换术（TAVR）彻底改变了严重主动脉瓣狭窄（AS）的治疗方式，且手术数量不断增加。TAVR治疗的混合性主动脉瓣疾病（MAVD）越来越受到关注，因为与单纯AS患者相比，这些患者群体更为复杂。然而，目前仅有关于该群体长期预后的有限数据。本研究的目的是评估TAVR患者中MAVD的患病率，研究其与瓣周反流（PVR）的相关性，并分析其对TAVR术后长期死亡率的影响。
我们利用维也纳TAVR注册数据库进行了一项基于注册登记的队列研究，纳入2007年1月至2020年5月在维也纳医科大学接受TAVR且术前和术后均有经胸超声心动图检查结果的患者（n = 880）。数据分析包括PVR发生率和长期生存结果。880例患者中，共有647例（73.52%）除严重AS外还伴有≥轻度主动脉瓣反流。与单纯AS相比，MAVD与PVR相关，比值比为2.06，95%置信区间（CI）：1.51 - 2.81（P = <0.001）。与无PVR相比，TAVR术后出现超过轻度PVR（880例中有168例：19.09%）与更高的死亡率相关，风险比（HR）为1.33，95% CI：1.05 - 1.67（P = 0.016）。与无PVR相比，TAVR术后发生≥轻度PVR的MAVD患者也与更高的死亡率相关，HR为1.30，95% CI：1.04 - 1.62（P = 0.022）。
MAVD在TAVR患者中很常见，并带来了独特的挑战，与单纯AS相比，其PVR风险增加且预后更差。MAVD患者的长期生存受到影响，不仅限于TAVR术后发生PVR的患者。在结构性心肌损伤或外科瓣膜置换发生之前进行早期干预可能是改善预后的一种潜在方法。
