经导管主动脉瓣置换术治疗二叶式主动脉瓣狭窄后人工瓣膜-患者不匹配的发生率及预后
Incidence and Prognosis of Prosthesis-Patient Mismatch After Transcatheter Aortic Valve Replacement for Bicuspid Aortic Stenosis.
作者信息
Yamanaka Futoshi, Shishido Koki, Moriyama Noriaki, Ochiai Tomoki, Miyashita Hirokazu, Yokoyama Hiroaki, Sugiyama Yoichi, Yashima Fumiaki, Ohno Yohei, Nishina Hidetaka, Izumo Masaki, Asami Masahiko, Naganuma Toru, Mizutani Kazuki, Yamawaki Masahiro, Tada Norio, Shirai Shinichi, Noguchi Masahiko, Ueno Hiroshi, Takagi Kensuke, Watanabe Yusuke, Yamamoto Masanori, Saito Shigeru, Hayashida Kentaro
机构信息
Department of Cardiology, Shonan Kamakura General Hospital, Kamakura, Japan.
Department of Cardiology, Shonan Kamakura General Hospital, Kamakura, Japan.
出版信息
JACC Cardiovasc Interv. 2025 Feb 24;18(4):492-502. doi: 10.1016/j.jcin.2024.10.002. Epub 2025 Jan 8.
BACKGROUND
Evidence regarding the incidence of prosthesis-patient mismatch (PPM) and long-term mortality after transcatheter aortic valve replacement (TAVR) in patients with bicuspid aortic valve stenosis (AS) is scarce.
OBJECTIVES
This study sought to assess the incidence and prognostic impact of PPM after TAVR for bicuspid AS compared with that for tricuspid AS.
METHODS
In total, 7,393 patients who underwent TAVR were prospectively enrolled in the OCEAN-TAVI (Optimized Catheter Valvular Intervention Transcatheter Aortic Valve Implantation) registry, an ongoing Japanese, multicenter registry. We analyzed 7,051 patients (median age = 85 years, 68.4% women) and identified 503 (7.1%) with bicuspid AS. We compared the incidence of PPM and long-term mortality in 497 patients with and 497 without bicuspid AS after one-to-one propensity score matching analysis.
RESULTS
Among the 7,051 patients, moderate and severe PPM were observed in 756 (10.7%) and 92 (1.3%) patients, respectively. Upon Kaplan-Meier curve analysis of the overall cohort, severe PPM appeared to be associated with long-term mortality (log-rank test, P = 0.065). After propensity score matching analysis, moderate and severe PPM were more frequently observed among patients with tricuspid AS than patients with bicuspid AS (moderate PPM, 11.7% vs 4.4%; severe PPM, 1.4% vs 1.0%; P = 0.0001).
CONCLUSIONS
Severe PPM appeared to be associated with all-cause mortality. Moderate and severe PPM were more frequently observed in patients with tricuspid AS than patients with bicuspid AS.
背景
关于二叶式主动脉瓣狭窄（AS）患者经导管主动脉瓣置换术（TAVR）后人工瓣膜-患者不匹配（PPM）的发生率及长期死亡率的证据较少。
目的
本研究旨在评估二叶式AS患者TAVR术后PPM的发生率及其预后影响，并与三叶式AS患者进行比较。
方法
共有7393例行TAVR的患者前瞻性纳入OCEAN-TAVI（优化导管瓣膜介入经导管主动脉瓣植入）注册研究，这是一项正在进行的日本多中心注册研究。我们分析了7051例患者（中位年龄 = 85岁，68.4%为女性），并识别出503例（7.1%）二叶式AS患者。在进行一对一倾向评分匹配分析后，我们比较了497例有二叶式AS和497例无二叶式AS患者的PPM发生率及长期死亡率。
结果
在7051例患者中，分别有756例（10.7%）和92例（1.3%）观察到中度和重度PPM。对整个队列进行Kaplan-Meier曲线分析时，重度PPM似乎与长期死亡率相关（对数秩检验，P = 0.065）。倾向评分匹配分析后，三叶式AS患者中中度和重度PPM的发生率高于二叶式AS患者（中度PPM，11.7%对4.4%；重度PPM，1.4%对1.0%；P = 0.0001）。
结论
重度PPM似乎与全因死亡率相关。三叶式AS患者中中度和重度PPM的发生率高于二叶式AS患者。
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