Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Science and Peking Union Medical College, Beijing 100037, China.
Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Science and Peking Union Medical College, Beijing 100037, China.
Int J Cardiol. 2024 Jun 15;405:131948. doi: 10.1016/j.ijcard.2024.131948. Epub 2024 Mar 11.
We aim to compare the short and long-term outcomes for aortic stenosis (AS) patients undergone TAVR with and without ascending aorta dilation (AAD).
Consecutive patients diagnosed with native severe AS who underwent TAVR from September 2012 to September 2021 were enrolled. They were stratified into the moderate/severe dilation group (greatest ascending aorta width ≥ 45 mm) and the non/mild dilation group. Survival outcomes were illustrated using Kaplan-Meier curves and evaluated with the log-rank test. Data from patients with CT follow-up of >6 months was used to investigate the progression rate of AAD.
The study cohort comprised 556 patients, with a mean age of 75.5 ± 7.3 years. Among them, 107 patients (19.2%) had a moderate/severe AAD (≥45 mm), with an average diameter of 48.6 mm (±2.8). During hospitalization, both groups witnessed two cases of ascending aortic dissection (1.9% vs 0.4%, P = 0.380). The median follow-up duration was 3.9 years (95% CI: 3.8-4.0 years). No deaths were caused by aortic events and no patients experienced a new aortic dissection. The AAD cohort's 4-year all-cause and cardiovascular mortality rates were not significantly different to the non/mild dilation group's (log-rank test, P = 0.109 and P = 0.698, respectively). Follow-up CT data revealed that the rate of aortic dilation progression in the moderate/severe dilation group was not significantly different from that in the non/mild group (0.0 mm/year, 25-75%th: -0.3-0.2 vs 0.1 mm/year, 25-75%th: -0.3-0.4, P = 0.122).
This study found no significant difference regarding short-term and long-term outcomes in AS patients with/without moderate/severe AAD undergoing TAVR.
本研究旨在比较经导管主动脉瓣置换术（TAVR）治疗伴或不伴升主动脉扩张（AAD）的主动脉瓣狭窄（AS）患者的短期和长期结局。
连续纳入 2012 年 9 月至 2021 年 9 月期间接受 TAVR 治疗的确诊为原发性重度 AS 的患者。根据升主动脉最大宽度（≥45mm）将患者分为中重度扩张组（中度/重度扩张组）和非/轻度扩张组。采用 Kaplan-Meier 曲线描述生存结局，并采用对数秩检验进行评估。使用 CT 随访时间超过 6 个月的数据来评估 AAD 的进展率。
本研究共纳入 556 例患者，平均年龄为 75.5±7.3 岁。其中，107 例（19.2%）患者存在中重度 AAD（≥45mm），平均直径为 48.6±2.8mm。住院期间，两组各有 2 例升主动脉夹层（1.9% vs 0.4%，P=0.380）。中位随访时间为 3.9 年（95%可信区间：3.8-4.0 年）。无主动脉相关死亡病例，也无新发主动脉夹层患者。AAD 组患者 4 年全因死亡率和心血管死亡率与非/轻度扩张组无显著差异（对数秩检验，P=0.109 和 P=0.698）。随访 CT 数据显示，中重度扩张组的主动脉扩张进展率与非/轻度组无显著差异（0.0mm/年，25%-75%分位数：-0.3-0.2 vs 0.1mm/年，25%-75%分位数：-0.3-0.4，P=0.122）。
本研究发现，接受 TAVR 治疗的伴或不伴中重度 AAD 的 AS 患者的短期和长期结局无显著差异。
