Bartos Peter V, Molnar Balazs, Herold Zoltan, Dekany Gabor, Piroth Zsolt, Horvath Gergely, Ahres Abdelkrim, Heesch Christian M, Czobor Nikoletta R, Satish Sai, Pinter Tunde, Fontos Geza, Andreka Peter
Department of Cardiology, Gottsegen National Cardiovascular Center, 1096 Budapest, Hungary.
Károly Rácz Doctoral School of Clinical Medicine, Semmelweis University, 1085 Budapest, Hungary.
Rev Cardiovasc Med. 2023 Sep 18;24(9):255. doi: 10.31083/j.rcm2409255. eCollection 2023 Sep.
In high-risk patients with degenerated aortic bioprostheses, valve-in-valve (ViV) transcatheter aortic valve implantation (TAVI) has emerged as a less invasive alternative to surgical valve replacement. To compare outcomes of ViV and native valve (NV) TAVI procedures.
34 aortic ViV-TAVI performed between 2012 and 2022 using self-expanding valves, were included in this retrospective analysis. Propensity score matching (1:2 ratio, 19 criteria) was used to select a comparison NV-TAVI group from a database of 1206 TAVI procedures. Clinical and echocardiographic endpoints, short- and long-term all-cause mortality (ACM) and cardiovascular mortality (CVM) data were obtained. Subgroup analyses were completed according to the true internal diameter, dividing patients into a small ( 19 mm) valve group (SVG) and a large ( 19 mm) valve group (LVG).
Clinical outcomes of ViV- and NV-TAVI were comparable, including device success [88.2% vs. 91.1%, = 0.727], major adverse cardiovascular and cerebrovascular events [5.8% vs. 5.8%, = 1.000], hemodialysis need [5.8% vs. 2.9%, = 0.599], pacemaker need [2.9% vs. 11.7%, = 0.265], major vascular complications [2.9% vs. 1.4%, = 1.000], life-threatening or major bleeding [2.9% vs. 1.4%, = 1.000] and in-hospital mortality [8.8% vs. 5.9%, = 0.556]. There was a significant difference in the immediate post-intervention mean residual aortic valve gradient (MAVG) [14.6 8.5 mm Hg vs. 6.4 4.5 mm Hg, 0.0001], which persisted at 1 year [ = 0.0002]. There were no differences in 12- or 30-month ACM [11.8% vs. 8.8%, = 0.588; 23.5% vs. 27.9%, = 0.948], and CVM [11.8% vs. 7.3%, = 0.441; 23.5% vs. 16.2%, = 0.239]. Lastly, there was no difference in CVM at 1 year and 30 months [11.1% vs. 12.5%, = 0.889; 22.2% vs. 25.0%, = 0.742].
Analyzing a limited group (n = 34) of ViV-TAVI procedures out of 1206 TAVIs done at a single institution, ViV-TAVI appeared to be an acceptable approach in patients not deemed appropriate candidates for redo valve replacement surgery. Clinical outcomes of ViV-TAVI were comparable to TAVI for native valve stenosis.
在退化性主动脉生物瓣膜的高危患者中，瓣中瓣（ViV）经导管主动脉瓣植入术（TAVI）已成为外科瓣膜置换术侵入性较小的替代方法。比较ViV和原生瓣膜（NV）TAVI手术的结果。
本回顾性分析纳入了2012年至2022年间使用自膨胀瓣膜进行的34例主动脉ViV-TAVI手术。采用倾向评分匹配（1:2比例，19个标准）从1206例TAVI手术数据库中选择一个比较性NV-TAVI组。获取临床和超声心动图终点、短期和长期全因死亡率（ACM）和心血管死亡率（CVM）数据。根据真实内径进行亚组分析，将患者分为小瓣膜组（SVG，内径＜19mm）和大瓣膜组（LVG，内径≥19mm）。
ViV-TAVI和NV-TAVI的临床结果具有可比性，包括手术成功率[88.2%对91.1%，P = 0.727]、主要不良心血管和脑血管事件[5.8%对5.8%，P = 1.000]、需要血液透析[5.8%对2.9%，P = 0.599]、需要起搏器[2.9%对11.7%，P = 0.265]、主要血管并发症[2.9%对1.4%，P = 1.000]、危及生命或严重出血[2.9%对1.4%，P = 1.000]以及住院死亡率[8.8%对5.9%，P = 0.556]。干预后即刻平均残余主动脉瓣压差（MAVG）存在显著差异[14.6±8.5mmHg对6.4±4.5mmHg，P＜0.0001]，1年时仍存在差异[P = 0.0002]。12个月或30个月时的ACM[11.8%对8.8%，P = 0.588；23.5%对27.9%，P = 0.948]以及CVM[11.8%对7.3%，P = 0.441；23.5%对16.2%，P = 0.239]无差异。最后，1年和30个月时的CVM也无差异[11.1%对12.5%，P = 0.889；22.2%对25.0%，P = 0.742]。
在单一机构进行的1206例TAVI手术中分析了有限数量（n = 34）的ViV-TAVI手术，对于不被认为适合再次瓣膜置换手术的患者，ViV-TAVI似乎是一种可接受的方法。ViV-TAVI的临床结果与原生瓣膜狭窄的TAVI相当。
