Department of Cardiology, Stockholm South General Hospital, Stockholm, Sweden; Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.
Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden; Department of Cardiothoracic Surgery, Karolinska University Hospital, Stockholm, Sweden.
Am Heart J. 2024 Oct;276:70-82. doi: 10.1016/j.ahj.2024.07.009. Epub 2024 Jul 18.
The impact of prosthesis-patient mismatch (PPM) after transcatheter aortic valve replacement (TAVR) is uncertain. This study was performed to investigate the risk of all-cause mortality, heart failure hospitalization, and aortic valve reintervention in patients with and without predicted PPM after TAVR.
This nationwide, population-based cohort study included all patients who underwent transfemoral primary TAVR in Sweden from 2008 to 2022 in the SWEDEHEART register. PPM was defined according to published effective orifice areas for each valve model and size. The patients were divided into those with and without PPM. Additional baseline characteristics and outcome data were obtained from other national health data registers. Regression standardization was used to adjust for intergroup differences.
Of 8485 patients, 7879 (93%) had no PPM and 606 (7%) had PPM. The crude cumulative incidence of all-cause mortality at 1, 5, and 10 years in patients with versus without PPM was 7% versus 9%, 40% versus 44%, and 80% versus 85%, respectively. After regression standardization, there was no between-group difference in long-term mortality, and the absolute difference at 10 years was 1.5% (95% confidence interval, -2.9%-6.0%). The mean follow-up was 3.0 years (maximum, 14 years). There was no difference in the risk of heart failure hospitalization or aortic valve reintervention.
The risk of all-cause mortality, heart failure hospitalization, or aortic valve reintervention was not higher in patients with than without predicted PPM following TAVR. Furthermore, PPM was present in only 7% of patients, and severe PPM was almost nonexistent.
经导管主动脉瓣置换术（TAVR）后假体-患者不匹配（PPM）的影响尚不确定。本研究旨在探讨 TAVR 后预测有和无 PPM 的患者全因死亡率、心力衰竭住院率和主动脉瓣再介入风险。
本项全国性基于人群的队列研究纳入了 2008 年至 2022 年在瑞典 SWEDEHEART 注册中心接受经股动脉主 TAVR 的所有患者。根据每个瓣膜模型和尺寸的公布有效瓣口面积定义 PPM。将患者分为有 PPM 和无 PPM 两组。从其他国家健康数据登记处获得了其他基线特征和结局数据。采用回归标准化来调整组间差异。
在 8485 例患者中，7879 例（93%）无 PPM，606 例（7%）有 PPM。有和无 PPM 患者的 1、5 和 10 年全因死亡率的粗累积发生率分别为 7%比 9%、40%比 44%和 80%比 85%。经过回归标准化，两组间的长期死亡率无差异，10 年的绝对差异为 1.5%（95%置信区间，-2.9%~6.0%）。平均随访时间为 3.0 年（最长 14 年）。两组心力衰竭住院率或主动脉瓣再介入率无差异。
TAVR 后预测有 PPM 的患者与无 PPM 的患者相比，全因死亡率、心力衰竭住院率或主动脉瓣再介入风险并无升高。此外，仅有 7%的患者存在 PPM，且严重 PPM 几乎不存在。
