Baudo Massimo, Sicouri Serge, Cabrucci Francesco, Yamashita Yoshiyuki, Magouliotis Dimitrios E, Carnila Sarah M, Abramson Sandra V, Hawthorne Katie M, Jarrett Harish, Rodriguez Roberto, Goldman Scott M, Coady Paul M, Gnall Eric M, Gray William A, Gelsomino Sandro, Ramlawi Basel
Department of Cardiac Surgery Research, Lankenau Institute for Medical Research, Main Line Health, Wynnewood, PA 19096, USA.
Department of Cardiac Surgery, Lankenau Heart Institute, Main Line Health, Wynnewood, PA 19096, USA.
Medicina (Kaunas). 2025 Apr 9;61(4):686. doi: 10.3390/medicina61040686.
: Associated mitral regurgitation (MR) is frequently observed during transcatheter aortic valve implantation (TAVI). The progression of moderate MR remains undetermined, given uncertain clinical significance and natural history. This study aims to assess the evolution of moderate MR following TAVI. : Between 2018 and 2023, 1476 patients underwent TAVI. We excluded those with previous aortic or mitral valve interventions, endocarditis, concomitant percutaneous coronary intervention, or emergent procedures. Patients with severe aortic or tricuspid regurgitation or significant mitral stenosis were excluded. Ultimately, only patients with moderate MR were included, resulting in a final population of 154 patients. : Mean age was 81.4 ± 7.8 years, 48.1% (74/154) were female, and 48.1% (74/154) were functional MR. There was one surgical conversion due to annular rupture. Thirty-day mortality was 1.9% (3/154). Postoperative echocardiography showed 38 (24.7%) patients with none/trace MR, 91 (59.1%) with mild MR, 22 (14.3%) with moderate MR, and 3 (1.9%) with severe MR. Finally, according to the echocardiographic follow-up [median follow-up 1.0 (IQR: 0.1-1.2) years], 20.1% (31/154) had no/trace MR, 39.6% (61/154) had mild MR, 35.7% (55/154) had moderate MR, and 4.5% (7/154) had severe MR. Overall, 67 (43.5%) patients had any MR grade progression, 62 (40.3%) had stable disease, and 25 (16.2%) had any MR grade reduction at the last follow-up from the operation. No difference in MR evolution was seen between functional and primary MR. : Concomitant moderate MR during TAVI has a variable evolution over time. A more detailed characterization of patients with preoperative moderate MR undergoing TAVI is necessary to identify those with a disease progression risk.
经导管主动脉瓣植入术（TAVI）期间经常观察到合并二尖瓣反流（MR）。鉴于临床意义和自然病史不确定，中度MR的进展情况仍未明确。本研究旨在评估TAVI后中度MR的演变情况。
2018年至2023年期间，1476例患者接受了TAVI。我们排除了既往有主动脉或二尖瓣干预、心内膜炎、同期经皮冠状动脉介入治疗或急诊手术的患者。排除有严重主动脉或三尖瓣反流或显著二尖瓣狭窄的患者。最终，仅纳入中度MR患者，最终研究人群为154例患者。
平均年龄为81.4±7.8岁，48.1%（74/154）为女性，48.1%（74/154）为功能性MR。有1例因瓣环破裂转为外科手术。30天死亡率为1.9%（3/154）。术后超声心动图显示，38例（24.7%）患者无/微量MR，91例（59.1%）有轻度MR，22例（14.3%）有中度MR，3例（1.9%）有重度MR。最后，根据超声心动图随访[中位随访时间1.0（IQR：0.1 - 1.2）年]，20.1%（31/154）无/微量MR，39.6%（61/154）有轻度MR，35.7%（55/154）有中度MR，4.5%（7/154）有重度MR。总体而言，67例（43.5%）患者有任何MR分级进展，62例（40.3%）病情稳定，25例（16.2%）在末次随访时与手术时相比有任何MR分级降低。功能性MR和原发性MR在MR演变方面未见差异。
TAVI期间合并的中度MR随时间有不同的演变情况。对于接受TAVI的术前中度MR患者，需要更详细的特征描述以识别有疾病进展风险的患者。
