Benck Kelley N, Nesbitt Kristin, Dranow Elizabeth, Glotzbach Jason P, Tandar Anwar, Pereira Sara J
University of Miami Miller School of Medicine, Miami, Florida.
University of Utah Spencer Fox Eccles School of Medicine, Salt Lake City, Utah.
J Soc Cardiovasc Angiogr Interv. 2024 Mar;3(3 Pt A). doi: 10.1016/j.jscai.2023.101266. Epub 2024 Feb 5.
D2 aortic stenosis (AS) is the highest risk AS subtype with worse operative and mortality outcomes. This study aimed to investigate the quality of life (QoL) and left ventricular ejection fraction (LVEF) in patients with classic (D2 subtype) low-flow/low-gradient AS who underwent transcatheter aortic valve replacement (TAVR).
In total, 634 patients with severe AS underwent TAVR at our institution from 2014 to 2020, of whom 76 met criteria for classic D2 AS with reduced LVEF. Echocardiographic and clinical outcomes including mortality, stroke, pacemaker placement (PPM), and readmission at baseline were compared with those at 30 days and 1 year. QoL data were extracted from the Kansas City Cardiomyopathy Questionnaire (KCCQ-12).
The average baseline Society of Thoracic Surgeons risk score for patients with D2 AS was 7.66 ± 6.76. Patients with D2 AS reported improved QoL post-TAVR. The average baseline KCCQ-12 score was 39.5 ± 20, with improvement to 68.9 ± 20.6 at 30 days ( < .01) and 74.9 ± 17.5 at 1 year ( < .01). Mortality was 0% at 30 days and 18.4% at 1 year. The average baseline LVEF was 36.1 ± 9.4. Left ventricular function improved to 43.5 ± 12.9 ( <.001) at 30 days and 46.3 ± 11.2 ( = .03) at 1 year. Complications post-TAVR at 30 days included stroke (1.3%) and PPM (11.8%). Patients with D2 AS exhibited higher baseline conduction defects including atrial fibrillation and higher postoperative PPM than those with other subtypes.
Patients with D2 AS had significantly improved LVEF and QoL following TAVR at 30 days and 1 year. Postoperative rates of new PPM were higher than other subtypes, while stroke, dialysis, and mortality were lower than expected, supporting the benefit of TAVR in this high-risk group.
二叶式主动脉瓣狭窄（AS）是风险最高的AS亚型，手术和死亡结局较差。本研究旨在调查接受经导管主动脉瓣置换术（TAVR）的典型（D2亚型）低流量/低梯度AS患者的生活质量（QoL）和左心室射血分数（LVEF）。
2014年至2020年期间，共有634例重度AS患者在我院接受了TAVR，其中76例符合典型D2 AS且LVEF降低的标准。将基线时的超声心动图和临床结局（包括死亡率、中风、起搏器植入（PPM）和再入院情况）与30天和1年时的情况进行比较。从堪萨斯城心肌病问卷（KCCQ - 12）中提取QoL数据。
D2 AS患者的平均基线胸外科医师协会风险评分为7.66±6.76。D2 AS患者报告TAVR术后QoL有所改善。基线时KCCQ - 12的平均评分为39.5±20，30天时改善至68.9±20.6（P <.01），1年时为74.9±17.5（P <.01）。30天死亡率为0%，1年时为18.4%。平均基线LVEF为36.1±9.4。左心室功能在30天时改善至43.5±12.9（P <.001），1年时为46.3±11.2（P =.03）。TAVR术后30天的并发症包括中风（1.3%）和PPM（11.8%）。与其他亚型患者相比，D2 AS患者基线传导缺陷（包括心房颤动）发生率更高，术后PPM也更高。
D2 AS患者在TAVR术后30天和1年时LVEF和QoL有显著改善。新PPM的术后发生率高于其他亚型，而中风、透析和死亡率低于预期，这支持了TAVR对这一高危组患者的益处。
