Department of Cardiology, The Texas Heart Institute, Houston, TX, USA.
Center for Women's Heart and Vascular Health, The Texas Heart Institute, Houston, TX, USA.
J Cardiovasc Med (Hagerstown). 2024 Jul 1;25(7):529-538. doi: 10.2459/JCM.0000000000001629. Epub 2024 May 14.
This study assessed the outcomes of concomitant mitral valve disease and severe aortic stenosis in patients undergoing transcatheter aortic valve replacement (TAVR).
Echocardiographic data of 813 patients with severe aortic stenosis undergoing transfemoral TAVR were collected, and clinical outcomes were analyzed for individuals with mitral stenosis and mitral regurgitation.
The final cohort includes 788 patients with severe calcific aortic stenosis. Among single parameters of mitral stenosis, a smaller baseline mitral valve area (MVA) by the continuity equation and higher postprocedural mean mitral gradients (MMG) were associated with an increased risk of death at 1 year (P-values 0.02 and <0.01, respectively), but no correlation with outcomes was demonstrated after multivariate adjustment for major prognosticators. Mitral stenosis (based on MVA + MMG) was not associated with complications or mortality. Mitral regurgitation was present in 94.6% of the population at baseline and regressed by at least one grade post-TAVR in 28% of the patients. The improvement in mitral regurgitation was associated with a greater prosthetic effective orifice area (P-value 0.03). Significant (at least moderate) residual mitral regurgitation was correlated with short-term complications and shown to be an independent predictor of 1-year mortality (P-value 0.02, odds ratio (OR) 5.37, confidence interval 1.34-21.5).
Mitral regurgitation has a greater impact on TAVR patients than mitral stenosis as assessed by functional methods.
本研究评估了行经导管主动脉瓣置换术（TAVR）治疗的同时合并二尖瓣疾病和严重主动脉瓣狭窄患者的结局。
收集了 813 例经股动脉 TAVR 治疗的严重主动脉瓣狭窄患者的超声心动图数据，并对有二尖瓣狭窄和二尖瓣反流的患者进行了临床结局分析。
最终队列包括 788 例严重钙化性主动脉瓣狭窄患者。在二尖瓣狭窄的单一参数中，基线连续方程计算的二尖瓣瓣口面积（MVA）较小和术后平均二尖瓣跨瓣压差（MMG）较高与 1 年死亡风险增加相关（P 值分别为 0.02 和 <0.01），但多变量调整主要预后因素后，与结局无相关性。二尖瓣狭窄（基于 MVA+MMG）与并发症或死亡率无关。基线时 94.6%的患者存在二尖瓣反流，其中 28%的患者在 TAVR 后至少反流减少一个级别。二尖瓣反流的改善与更大的人工瓣膜有效瓣口面积相关（P 值 0.03）。明显（至少中度）的残余二尖瓣反流与短期并发症相关，并显示为 1 年死亡率的独立预测因素（P 值 0.02，比值比（OR）5.37，95%置信区间 1.34-21.5）。
与功能方法评估的二尖瓣狭窄相比，二尖瓣反流对 TAVR 患者的影响更大。
