Ostrowska-Kaim Elżbieta, Trębacz Jarosław, Kleczyński Paweł, Sobczynski Robert, Konstanty-Kalandyk Janusz, Musiał Robert, Gackowski Andrzej, Legutko Jacek, Żmudka Krzysztof, Kapelak Bogusław, Stąpór Maciej
Clinical Department of Interventional Cardiology, St. John Paul II Hospital, Kraków, Poland.
Noninvasive Cardiovascular Laboratory, St. John Paul II Hospital, Kraków, Poland.
Cardiol J. 2024;31(6):833-842. doi: 10.5603/cj.98792. Epub 2024 Aug 7.
The coexistence of mitral regurgitation (MR) and severe aortic stenosis (AS) has been associated with worse outcomes in patients undergoing transcatheter aortic valve implantation (TAVI). Herein, the aim was to assess the etiology and degree of MR in an unselected TAVI population and investigate the impact of MR reduction at mid-term follow-up.
Patients subjected to TAVI as a treatment for severe AS in a single center were retrospectively analyzed. The primary endpoint was the MR reduction after TAVI. The secondary endpoint was all-cause mortality and heart failure hospitalization at a 3-year follow-up.
Patients undergoing TAVI (n = 283) in the years 2017-2019 were screened for the presence of hemodynamically significant MR. Sixty-nine subjects (24.4%) with severe (16, 23.2%) and moderate (53, 76.8%) MR were included. The primary MR was predominant (39 subjects, 56.5%). The median age of the patients was 82 years. MR improved in 25 patients (36.2%, p < 0.001). Baseline severe MR was more prone to reduce (8 subjects, 50%) than moderate (17 subjects, 32.1%, p = 0.04). The primary MR improved in 14 patients (35.9%), while secondary in 11 patients (36.7%, p = 1). Patients showing MR reduction had lower mortality (8 vs. 29.55%, p = 0.047) and were less frequently hospitalized (20 vs. 45.45%, p = 0.03) at 3-year follow-up.
Hemodynamically significant MR improves after TAVI regardless of its etiology. Moreover, MR reduction after TAVI is associated with better clinical outcomes.
二尖瓣反流（MR）与严重主动脉瓣狭窄（AS）并存与经导管主动脉瓣植入术（TAVI）患者的不良预后相关。在此，目的是评估未选择的TAVI人群中MR的病因和程度，并研究中期随访时MR减轻的影响。
回顾性分析在单一中心接受TAVI治疗严重AS的患者。主要终点是TAVI后MR的减轻。次要终点是3年随访时的全因死亡率和心力衰竭住院率。
对2017年至2019年接受TAVI的患者（n = 283）进行血流动力学显著MR的筛查。纳入69例严重（16例，23.2%）和中度（53例，76.8%）MR患者。原发性MR占主导（39例，56.5%）。患者的中位年龄为82岁。25例患者（36.2%，p < 0.001）的MR有所改善。基线严重MR比中度MR更易减轻（8例，50%对比17例，32.1%，p = 0.04）。原发性MR在14例患者（35.9%）中有所改善，继发性MR在11例患者（36.7%，p = 1）中有所改善。在3年随访时，MR减轻的患者死亡率较低（8%对比29.55%，p = 0.047）且住院频率较低（20%对比45.45%，p = 0.03）。
无论病因如何，血流动力学显著的MR在TAVI后都会改善。此外，TAVI后MR的减轻与更好的临床结局相关。
