Department of Cardiology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, People's Republic of China.
School of Medicine South China University of Technology, Guangzhou, People's Republic of China.
Clin Interv Aging. 2024 May 1;19:695-703. doi: 10.2147/CIA.S447272. eCollection 2024.
In mixed aortic valve disease (MAVD), the results of transcatheter aortic valve replacement (TAVR) are conflicting. There is limited data on the outcomes of TAVR in patients with bicuspid aortic valve (BAV) and MAVD. The objective of this study is to compare outcomes after TAVR in BAV patients with MAVD and predominant aortic stenosis (PAS).
Patients with BAV who underwent TAVR between January 2016 and April 2023 were included. The primary outcome was device success. The secondary endpoints were periprocedural mortality and other complications as defined by the Valve Academic Research Consortium-3 (VARC-3). Propensity score matching was used to minimize potential confounding.
A total of 262 patients were included in this study, 83 of whom had MAVD. The median age was 72 years, and 55.7% were male. The baseline comorbidity risk files were comparable between the two groups. Patients with MAVD had more mitral regurgitation, tricuspid regurgitation and pulmonary hypertension, larger annular and left ventricular outflow tract dimensions, and more severe calcification than PAS. In the unmatched population, MAVD patients had similar device success rate (69.9% vs 79.9%, =0.075) and 30-day mortality (3.6% vs 3.4%, =1) compared to PAS. Propensity score matching resulted in 66 patient pairs. Device success rate were still comparable in the matched population. Other clinical outcomes, including stroke, bleeding (type 2-4), major vascular complications, acute kidney injury (stage 2-4) and permanent pacemaker implantation, were comparable between the two groups. Multivariable logistic regression analysis did not show MAVD to be an independent negative predictor of device success. At one year, survival was similar between patients with MAVD and those with PAS.
For the bicuspid valve, patients with MAVD had a more challenging anatomy. MAVD patients associated with comparable 30-day clinical outcomes after TAVR compared to PAS patients in patients with BAV.
在主动脉瓣混合病变（MAVD）中，经导管主动脉瓣置换术（TAVR）的结果存在争议。关于二叶式主动脉瓣（BAV）和 MAVD 患者 TAVR 结局的数据有限。本研究的目的是比较 MAVD 伴主瓣狭窄（PAS）和主动脉瓣二叶畸形（BAV）患者 TAVR 后的结局。
纳入 2016 年 1 月至 2023 年 4 月期间接受 TAVR 的 BAV 患者。主要终点是器械成功。次要终点是根据 Valve Academic Research Consortium-3（VARC-3）定义的围手术期死亡率和其他并发症。采用倾向评分匹配来最小化潜在的混杂因素。
共有 262 例患者纳入本研究，其中 83 例为 MAVD。中位年龄为 72 岁，55.7%为男性。两组的基线合并症风险评分相当。MAVD 患者二尖瓣反流、三尖瓣反流和肺动脉高压更多，瓣环和左心室流出道尺寸更大，钙化程度更严重。在未匹配的人群中，MAVD 患者的器械成功率（69.9% vs 79.9%，=0.075）和 30 天死亡率（3.6% vs 3.4%，=1）与 PAS 患者相似。倾向评分匹配后共纳入 66 对患者。匹配人群的器械成功率仍相当。其他临床结局，包括卒中和出血（2-4 型）、大血管并发症、急性肾损伤（2-4 期）和永久性起搏器植入，两组间无差异。多变量逻辑回归分析显示 MAVD 不是器械成功的独立负预测因素。一年时，MAVD 患者和 PAS 患者的生存率相似。
对于二叶瓣，MAVD 患者的解剖结构更具挑战性。在 BAV 患者中，与 PAS 患者相比，MAVD 患者的 TAVR 后 30 天临床结局相似。
