Fogelson Benjamin, Baljepally Raj, Heidel Eric, Ferlita Steve, Moodie Travis, Amro Aladen, Weston Stefan
Department of Medicine, University of Tennessee Graduate School of Medicine, Knoxville, TN, USA.
Division of Cardiology, University of Tennessee Medical Center Knoxville, Knoxville, TN 37920, USA.
Cardiol Res. 2025 Jul 28;16(4):312-320. doi: 10.14740/cr2086. eCollection 2025 Aug.
Following transcatheter aortic valve implantation (TAVI), transvalvular mean gradient is known to increase from immediate to 24 h post-procedure. While anesthesia, rapid-pacing, and volume status are blamed, the true etiology is unclear. To our knowledge, no prior studies have evaluated the effects of mitral regurgitation (MR) on the rise in post-TAVI transvalvular mean gradient.
A single-center, retrospective analysis of patients who underwent TAVI at our institution between 2011 to 2020 was performed (n = 378, males = 206). Patients were divided into two groups, no-to-mild MR (n = 327) and moderate-to-severe MR (n = 51) based on echocardiograms obtained prior to TAVI. Transvalvular gradients were compared between immediate and 24-h post-TAVI echocardiograms.
The average age of no-to-mild MR patients (77 years (interquartile range (IQR): 71 - 84)) was similar to moderate-to-severe MR patients (79 years (IQR: 76 - 85), p=0.13). Both groups had similar procedural blood pressures and peri-procedural medication use. The change in 24-h post-TAVI mean transvalvular gradient was +6 mm Hg (IQR: 3.7 - 9) in the moderate-to-severe MR group and +6 mm Hg (IQR: 3.4 - 9) in the no-to-mild MR group (P = 0.87).
In this study, we evaluated the impact of preexisting MR on changes in transvalvular gradients following TAVI. We observed no statistically significant difference in 24-h post-TAVI gradient changes between patients with moderate-to-severe MR and those with no-to-mild MR. These findings suggest that baseline MR may not be a major determinant of early post-TAVI hemodynamics; however, further prospective studies are needed to confirm this observation.
经导管主动脉瓣植入术（TAVI）后，经瓣平均压差在术后即刻至24小时会升高。虽然麻醉、快速起搏和容量状态被认为是原因，但真正的病因尚不清楚。据我们所知，此前尚无研究评估二尖瓣反流（MR）对TAVI后经瓣平均压差升高的影响。
对2011年至2020年在我院接受TAVI的患者进行单中心回顾性分析（n = 378，男性 = 206）。根据TAVI术前超声心动图将患者分为两组，无至轻度MR组（n = 327）和中度至重度MR组（n = 51）。比较TAVI术后即刻和24小时超声心动图的经瓣压差。
无至轻度MR患者的平均年龄为77岁（四分位间距（IQR）：71 - 84），与中度至重度MR患者（79岁（IQR：76 - 85），p = 0.13）相似。两组患者的术中血压和围手术期用药情况相似。中度至重度MR组TAVI术后24小时平均经瓣压差变化为+6 mmHg（IQR：3.7 - 9），无至轻度MR组为+6 mmHg（IQR：3.4 - 9）（P = 0.87）。
在本研究中，我们评估了术前MR对TAVI后经瓣压差变化的影响。我们观察到，中度至重度MR患者与无至轻度MR患者在TAVI术后24小时压差变化方面无统计学显著差异。这些发现表明，基线MR可能不是TAVI术后早期血流动力学的主要决定因素；然而，需要进一步的前瞻性研究来证实这一观察结果。
