Matsuura Kaoru, Kumamaru Hiraku, Kohsaka Shun, Kanda Tomoyoshi, Kitahara Hideki, Shimamura Kazuo, Kobayashi Yoshio, Matsumiya Goro
Department of Cardiovascular Surgery, Chiba University Graduate School of Medicine, Chiba University Hospital, 1-8-1 Inohana, Chuo Ward, Chiba, Chiba, 260-0856, Japan.
Department of Healthcare Quality Assessment, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
Heart Vessels. 2025 Jun;40(6):523-530. doi: 10.1007/s00380-024-02491-6. Epub 2024 Dec 19.
This study aims to compare 1-year outcomes after transcatheter aortic valve replacement (TAVR) between patients with moderate-severe MR and severe MR preoperatively using the Japan Transcatheter Valve Therapy (J-TVT) registry. Patients undergoing TAVR for aortic stenosis between August 2013 and December 2019 with preoperative mitral regurgitation of moderate-severe (group MR3) or severe (group MR4) were included. Patients with a history of valve surgery and dialysis patients were excluded. A total of 2017 patients were included, and 1-year follow-up data were obtained from the registry (follow-up rate 98.5%). Propensity-score matching between MR3 and MR4 groups was performed. All-cause mortality and the composite outcome of death and/or heart failure events were compared. Crude data showed that 1-year survival was significantly higher in the MR 3 (89.8%) than MR 4 (84.7%) groups, and freedom from 1-year mortality and heart failure events was also higher in the MR 3 (87.1%) than MR 4 (80.5%) groups (p = 0.0001). After propensity-score matching, 452 cases (226 cases each in MR 3 group and MR 4 group) were extracted. Cox regression model showed no statistical difference in the 1-year survival rate between MR 3 group (84.5%) and MR 4 group (85.5%) (p = 0.84), nor in freedom from 1-year death and/or heart failure events between MR 3 group (80.2%) and MR 4 group (81.6%) (p = 0.72). The 1-year survival rate and freedom from death and/or heart failure events were found to be similar between patients undergoing TAVR with MR grade 3 and MR grade 4.
本研究旨在利用日本经导管瓣膜治疗（J-TVT）注册研究，比较术前中度至重度二尖瓣反流（MR）和重度MR患者经导管主动脉瓣置换术（TAVR）后的1年结局。纳入2013年8月至2019年12月期间因主动脉狭窄接受TAVR且术前二尖瓣反流为中度至重度（MR3组）或重度（MR4组）的患者。排除有瓣膜手术史的患者和透析患者。共纳入2017例患者，并从注册研究中获取1年随访数据（随访率98.5%）。对MR3组和MR4组进行倾向评分匹配。比较全因死亡率以及死亡和/或心力衰竭事件的复合结局。原始数据显示，MR3组（89.8%）的1年生存率显著高于MR4组（84.7%），MR3组（87.1%）无1年死亡和心力衰竭事件的比例也高于MR4组（80.5%）（p = 0.0001）。倾向评分匹配后，提取452例（MR3组和MR4组各226例）。Cox回归模型显示，MR3组（84.5%）和MR4组（85.5%）的1年生存率无统计学差异（p = 0.84），MR3组（80.2%）和MR4组（81.6%）无1年死亡和/或心力衰竭事件的比例也无统计学差异（p = 0.72）。结果发现，MR3级和MR4级患者接受TAVR后的1年生存率以及无死亡和/或心力衰竭事件的比例相似。
