Asmarats Lluis, Jiménez-Quevedo Pilar, Amat-Santos Ignacio J, Ferrer-Gracia María-Cruz, Sarnago Fernando, Alonso-Briales Juan H, Oteo Juan Francisco, Serra Vicenç, Muntané-Carol Guillem, Vilalta Victoria, Del Val David, Pan Manuel, De la Torre Hernández José M, García-Blas Sergio, Díez José Luis, Berenguer Alberto, Del Valle Raquel, Navarro Del Amo Felipe, Artaiz Miguel, Regueiro Ander, López-Pérez Manuel, Massó van-Roessel Albert, Paredes-Vázquez José G, Fernández-Cordón Clara, Diarte de Miguel José Antonio, Maneiro Nicolás, Piserra-López Alberto, De La Fuente Jorge, Muñoz Juan, Romaguera Rafael, Carrillo Xavier, Alfonso Fernando, Alvarado Marco, Veiga Gabriela, Millán Xavier, Nombela-Franco Luis, Arzamendi Dabit
Hospital Santa Creu i Sant Pau, Institut de Recerca Sant Pau (IR SANT PAU), Barcelona, Spain.
Cardiovascular Institute, Hospital Clínico San Carlos, Madrid, Spain.
Can J Cardiol. 2025 Aug;41(8):1480-1489. doi: 10.1016/j.cjca.2025.04.026. Epub 2025 May 7.
Pre-existing mitral prosthesis raises technical challenges for transcatheter aortic valve replacement (TAVR) but has been scarcely studied. In this work we sought to compare outcomes of patients with previous surgical mitral valve prostheses undergoing TAVR with balloon-expandable valve (BEV) or self-expanding valve (SEV) systems.
Patients from the Spanish TAVR registry with pre-existing surgical mitral prostheses were included in this investigation. The primary endpoints were Valve Academic Research Consortium-3 technical and device success, with analysis according to valve type. Transcatheter heart valve (THV) embolization, mitral valve impingement, THV performance, and pacemaker findings were also assessed.
A total of 243 patients were included (37% BEVs, 63% SEVs). Overall technical success was 95.9%. Thirty-day device success was higher in BEV patients (94.4% vs 85.0%, P = 0.036), mainly driven by fewer incidences of moderate residual aortic regurgitation (0% vs 5.9%, P = 0.028) and THV embolization (0% vs 3.9%, P = 0.087). BEV recipients exhibited higher mean transvalvular gradients (10.5 vs 8.1 mm Hg, P = 0.002) and lower rates of permanent pacemaker implantation (5.6% vs 15.7%, P = 0.023). There were no differences in mortality, bleeding, or readmission at 30 days. In the multivariate analysis, a mitroaortic distance of ≤ 7 mm and lack of transesophageal echocardiography guidance were associated with increased device failure.
In patients with pre-existing MV prostheses, TAVR was safe and effective regardless of the THV type. Nevertheless, the use of BEVs resulted in an increased rate of device success, driven by lesser THV embolization and residual aortic regurgitation.
已有的二尖瓣人工瓣膜给经导管主动脉瓣置换术（TAVR）带来了技术挑战，但相关研究较少。在本研究中，我们旨在比较接受球囊扩张瓣膜（BEV）或自膨胀瓣膜（SEV）系统TAVR的既往接受二尖瓣手术置换人工瓣膜患者的结局。
本研究纳入了西班牙TAVR注册研究中既往接受二尖瓣手术置换人工瓣膜的患者。主要终点为瓣膜学术研究联盟-3（Valve Academic Research Consortium-3）定义的技术成功和器械成功，并根据瓣膜类型进行分析。还评估了经导管心脏瓣膜（THV）栓塞、二尖瓣撞击、THV性能和起搏器植入情况。
共纳入243例患者（37%为BEV，63%为SEV）。总体技术成功率为95.9%。BEV患者30天器械成功率更高（94.4%对85.0%，P = 0.036），主要原因是中度残余主动脉瓣反流（0%对5.9%，P = 0.028）和THV栓塞发生率较低（0%对3.9%，P = 0.087）。接受BEV的患者平均跨瓣压差更高（10.5对8.1 mmHg，P = 0.002），永久起搏器植入率更低（5.6%对15.7%，P = 0.023）。30天时死亡率、出血或再入院率无差异。多因素分析显示，二尖瓣-主动脉距离≤7 mm和缺乏经食管超声心动图引导与器械失败增加相关。
在已有二尖瓣人工瓣膜的患者中，无论使用何种THV类型，TAVR都是安全有效的。然而，使用BEV可提高器械成功率，主要得益于较少的THV栓塞和残余主动脉瓣反流。
