Cammertoni Federico, Pavone Natalia, Bruno Piergiorgio, Di Giammarco Gabriele, Burzotta Francesco, Romagnoli Enrico, Lombardo Antonella, Graziani Francesca, Nesta Marialisa, Grandinetti Maria, D'Avino Serena, Marcolini Alberta, Cutrone Gessica, D'Acierno Edoardo Maria, Panzera Rudy, Mazzenga Gabriele, Montesano Marco, Massetti Massimo
Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy.
Faculty of Medicine and Surgery, Catholic University of the Sacred Heart, 00168 Rome, Italy.
J Clin Med. 2025 Jan 5;14(1):267. doi: 10.3390/jcm14010267.
According to current guidelines, patients with heart valve disease should be followed by Heart Valve Clinics (HVCs). Regular quality analysis is a major prerequisite of an HVC's program, but few data have been reported so far. We retrospectively collected patients with isolated, native aortic valve stenosis who had been visited in our HVC at least once between 2021 and 2024. For each outpatient visit, symptoms, physical examination, echocardiographic data, complementary tests, and indications were acquired. Also, adverse events (hospitalization, unplanned procedures, and death) were retrieved. A total of 320 patients were included. Mean visits/patient ratio was 1.2. At the first visit, 69.7% already had severe aortic stenosis, and severe symptoms (NYHA ≥ III) were evident in 24.4%. In addition, 26.5%, 59.1%, 12.8%, and 1.6% were in Généreux stage I, II, III, and IV, respectively. Overall, 197 (78.5%) and 54 (21.5%) patients received an indication for transcatheter AVR and surgical AVR, respectively. AVR-free survival was 46%, 23%, and 6% at 6, 12, and 24 months, respectively (mean 8.8 months CI95% 7.7-9.9). Adverse event-free survival was 97.2%, 95.5%, and 85% at 3, 6, and 12 months, respectively. Patients referred to our HVC already had an advanced disease with cardiac damage. Transcatheter AVR was mostly indicated, and it showed excellent short-term results. A low rate of adverse events was seen among patients in follow-up, but the odds of receiving AVR were high and driven by Généreux's stage. Despite these favorable results, further efforts to sensitize earlier patient referral should be made.
根据现行指南，心脏瓣膜病患者应由心脏瓣膜诊所（HVCs）进行随访。定期质量分析是HVC项目的主要前提条件，但目前报道的数据较少。我们回顾性收集了2021年至2024年期间至少在我们的HVC就诊过一次的孤立性、原发性主动脉瓣狭窄患者。对于每次门诊就诊，收集症状、体格检查、超声心动图数据、辅助检查和适应症。此外，还检索了不良事件（住院、非计划手术和死亡）。共纳入320例患者。平均每位患者就诊次数为1.2次。首次就诊时，69.7%的患者已患有严重主动脉瓣狭窄，24.4%的患者有严重症状（纽约心脏协会心功能分级≥III级）。此外，分别有26.5%、59.1%、12.8%和1.6%的患者处于热雷（Généreux）I期、II期、III期和IV期。总体而言，分别有197例（78.5%）和54例（21.5%）患者接受了经导管主动脉瓣置换术（AVR）和外科AVR的适应症。在6个月、12个月和24个月时，无AVR生存率分别为46%、23%和6%（平均8.8个月，95%置信区间7.7 - 9.9）。在3个月、6个月和12个月时，无不良事件生存率分别为97.2%、95.5%和85%。转诊至我们HVC的患者已患有晚期疾病并伴有心脏损害。经导管AVR是主要的治疗手段，且显示出优异的短期效果。随访患者中不良事件发生率较低，但接受AVR的几率较高，且受热雷分期的影响。尽管取得了这些良好结果，但仍应进一步努力提高患者早期转诊的意识。
