Lin Da-Wei, Weng Zi-Long, Fan Jia-Ning, Long Yu-Liang, Guan Li-Hua, Pan Wen-Zhi, Zhou Da-Xin, Ge Jun-Bo
Department of Cardiology, Zhongshan Hospital, Fudan University, 200032 Shanghai, China.
National Clinical Research Center for Interventional Medicine, 200032 Shanghai, China.
Rev Cardiovasc Med. 2024 Aug 23;25(8):307. doi: 10.31083/j.rcm2508307. eCollection 2024 Aug.
In recent years, transcatheter aortic valve replacement (TAVR) has emerged as a pivotal treatment for pure native aortic regurgitation (PNAR). Given patients with severe aortic regurgitation (AR) are prone to suffer from pulmonary hypertension (PH), understanding TAVR's efficacy in this context is crucial. This study aims to explore the short-term prognosis of TAVR in PNAR patients with concurrent PH.
Patients with PNAR undergoing TAVR at Zhongshan Hospital, Affiliated with Fudan University, were enrolled between June 2018 to June 2023. They were categorized based on pulmonary artery systolic pressure (PASP) into groups with or without PH. The baseline characteristics, imaging records, and follow-up data were collected.
Among the 103 patients recruited, 48 were afflicted with PH. In comparison to PNAR patients without PH, the PH group exhibited higher rates of renal dysfunction (10.4% vs. 0.0%, = 0.014), increased Society of Thoracic Surgeons scores (6.4 1.9 vs. 4.7 1.6, 0.001), and elevated Nterminal fragment of pro-brain natriuretic peptide (NT-proBNP). Transthoracic ultrasound examination revealed that patients with PH displayed lower left ventricular ejection fraction, larger left ventricle dimension, and more frequent moderate to severe tcuspid regurgitation (TR). Following TAVR, both groups experienced significant reductions in PASP, mitral regurgitation (MR) and TR. There were no significant differences in the incidence of postoperative adverse events in patients with or without PH.
We found TAVR to be a safe and effective treatment for patients with PNAR and PH, reducing the degree of aortic regurgitation and PH without increasing the risk of postoperative adverse events.
近年来，经导管主动脉瓣置换术（TAVR）已成为单纯原发性主动脉瓣反流（PNAR）的关键治疗方法。鉴于重度主动脉瓣反流（AR）患者易患肺动脉高压（PH），了解TAVR在此情况下的疗效至关重要。本研究旨在探讨TAVR治疗合并PH的PNAR患者的短期预后。
选取2018年6月至2023年6月在复旦大学附属中山医院接受TAVR治疗的PNAR患者。根据肺动脉收缩压（PASP）将他们分为有或无PH组。收集基线特征、影像学记录和随访数据。
在纳入的103例患者中，48例患有PH。与无PH的PNAR患者相比，PH组肾功能不全发生率更高（10.4%对0.0%，P = 0.014），胸外科医师协会评分更高（6.4±1.9对4.7±1.6，P<0.001），且脑钠肽前体N末端片段（NT-proBNP）升高。经胸超声检查显示，PH患者左心室射血分数较低，左心室尺寸较大，中度至重度三尖瓣反流（TR）更常见。TAVR术后，两组患者的PASP、二尖瓣反流（MR）和TR均显著降低。有无PH患者术后不良事件发生率无显著差异。
我们发现TAVR是治疗PNAR和PH患者的安全有效方法，可降低主动脉瓣反流和PH程度，且不增加术后不良事件风险。
