Saijo Yoshihito, Kusunose Kenya, Takahashi Tomonori, Yamada Hirotsugu, Sata Masataka, Sato Kimi, Albakaa Noor, Ishizu Tomoko, Seo Yoshihiro
Cardiovascular Department Tokushima University Hospital Tokushima Japan.
Department of Cardiovascular Medicine, Nephrology and Neurology University of the Ryukyus Okinawa Japan.
J Am Heart Assoc. 2024 Feb 20;13(4):e033289. doi: 10.1161/JAHA.123.033289. Epub 2024 Feb 16.
The management of mixed aortic valve disease (MAVD), defined as the concomitant presence of aortic stenosis (AS) and aortic regurgitation, remains a clinical challenging. The present study assessed the impact of transcatheter aortic valve replacement (TAVR) on cardiac geometry and prognosis in patients with MAVD.
A retrospective multicenter TAVR registry was conducted, including patients who underwent TAVR for severe symptomatic AS between January 2015 and March 2019. Patients were subdivided into 2 groups according to concomitant presence of moderate or more severe aortic regurgitation as the MAVD group, and with mild or less severe aortic regurgitation as the isolated AS group. The primary outcome was a composite of cardiovascular death and rehospitalization due to cardiovascular causes. A total of 1742 patients (isolated AS, 1522 patients; MAVD, 220 patients) were included (84.0±5.2 years). Although MAVD exhibited significantly larger left ventricular volumes and higher left ventricular mass index at the TAVR procedure than isolated AS (respectively, <0.001), MAVD showed a greater improvement of left ventricular volumes and left ventricular mass index after TAVR (respectively, ≤0.001). During a median follow-up of 747 days, 301 patients achieved the primary event. The prognosis post-TAVR was comparable between the 2 groups (log-rank =0.65). Even after adjustment using propensity score matching to reduce the potential bias between the 2 groups, similar results were obtained for the entire cohort.
Despite more advanced cardiac remodeling in MAVD at the time of TAVR compared with isolated AS, a greater improvement of cardiac reverse remodeling was found in MAVD, and the prognosis following TAVR was comparable between the 2 groups.
混合性主动脉瓣疾病（MAVD）定义为主动脉瓣狭窄（AS）和主动脉瓣反流同时存在，其治疗仍然是一项具有临床挑战性的工作。本研究评估了经导管主动脉瓣置换术（TAVR）对MAVD患者心脏几何形态和预后的影响。
进行了一项回顾性多中心TAVR注册研究，纳入2015年1月至2019年3月期间因严重症状性AS接受TAVR的患者。根据是否存在中度或更严重的主动脉瓣反流，将患者分为两组，存在中度或更严重主动脉瓣反流的为MAVD组，存在轻度或较轻主动脉瓣反流的为单纯AS组。主要结局是心血管死亡和因心血管原因再次住院的复合终点。共纳入1742例患者（单纯AS组1522例；MAVD组220例）（年龄84.0±5.2岁）。虽然MAVD在TAVR手术时的左心室容积和左心室质量指数显著大于单纯AS组（均P<0.001），但MAVD在TAVR术后左心室容积和左心室质量指数的改善更大（均P≤0.001）。在中位随访747天期间，301例患者发生了主要事件。两组TAVR术后的预后相当（对数秩检验P=0.65）。即使在使用倾向评分匹配进行调整以减少两组之间的潜在偏倚后，整个队列仍获得了相似的结果。
尽管与单纯AS相比，MAVD在TAVR时的心脏重构更严重，但MAVD的心脏逆向重构改善更大，且两组TAVR术后的预后相当。
