评估双尖瓣混合病变与主动脉瓣狭窄为主的经导管主动脉瓣置换术的疗效

IF 3.6 3区医学

Clinical Interventions in Aging Pub Date : 2024-05-01 DOI:10.2147/cia.s447272

Changjin Wang, Xiaolu Hu, Songyuan Luo, Yinghao Sun, Bangyuan Yang, Shengneng Zheng, Jiaohua Chen, Ming Fu, Ruixin Fan, Jie Li, Jianfang Luo

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引用次数: 0

摘要

目的：对于混合性主动脉瓣疾病（MAVD），经导管主动脉瓣置换术（TAVR）的结果并不一致。有关双尖瓣主动脉瓣（BAV）和混合性主动脉瓣病变患者 TAVR 治疗效果的数据十分有限。本研究的目的是比较伴有 MAVD 和主动脉瓣狭窄（PAS）的 BAV 患者进行 TAVR 后的疗效：纳入在 2016 年 1 月至 2023 年 4 月期间接受 TAVR 的 BAV 患者。主要结果为设备成功率。次要终点是瓣膜学术研究联盟-3（VARC-3）定义的围手术期死亡率和其他并发症。研究采用倾向评分匹配法，以尽量减少潜在的混杂因素：本研究共纳入了 262 名患者，其中 83 人患有 MAVD。中位年龄为 72 岁，55.7% 为男性。两组患者的基线合并症风险档案相当。与PAS相比，MAVD患者有更多的二尖瓣反流、三尖瓣反流和肺动脉高压，瓣环和左心室流出道尺寸更大，钙化更严重。在未匹配人群中，MAVD患者的设备成功率（69.9% vs 79.9%，P=0.075）和30天死亡率（3.6% vs 3.4%，P=1）与PAS相似。倾向评分匹配产生了 66 对患者。配对人群的设备成功率仍具有可比性。其他临床结果，包括中风、出血（2-4 型）、主要血管并发症、急性肾损伤（2-4 期）和永久起搏器植入，两组之间也具有可比性。多变量逻辑回归分析表明，MAVD 并非器械成功率的独立负向预测因素。一年后，MAVD和PAS患者的存活率相似：结论：对于双尖瓣来说，MAVD患者的解剖结构更具挑战性。关键词：经导管主动脉瓣置换术，混合性主动脉瓣疾病，双尖瓣，装置成功率，倾向评分匹配

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Assess the Outcomes of Transcatheter Aortic Valve Replacement in Bicuspid Valve with Mixed Disease versus Predominant Aortic Stenosis

Purpose: In mixed aortic valve disease (MAVD), the results of transcatheter aortic valve replacement (TAVR) are conflicting. There is limited data on the outcomes of TAVR in patients with bicuspid aortic valve (BAV) and MAVD. The objective of this study is to compare outcomes after TAVR in BAV patients with MAVD and predominant aortic stenosis (PAS).
Patients and Methods: Patients with BAV who underwent TAVR between January 2016 and April 2023 were included. The primary outcome was device success. The secondary endpoints were periprocedural mortality and other complications as defined by the Valve Academic Research Consortium-3 (VARC-3). Propensity score matching was used to minimize potential confounding.
Results: A total of 262 patients were included in this study, 83 of whom had MAVD. The median age was 72 years, and 55.7% were male. The baseline comorbidity risk files were comparable between the two groups. Patients with MAVD had more mitral regurgitation, tricuspid regurgitation and pulmonary hypertension, larger annular and left ventricular outflow tract dimensions, and more severe calcification than PAS. In the unmatched population, MAVD patients had similar device success rate (69.9% vs 79.9%, P=0.075) and 30-day mortality (3.6% vs 3.4%, P=1) compared to PAS. Propensity score matching resulted in 66 patient pairs. Device success rate were still comparable in the matched population. Other clinical outcomes, including stroke, bleeding (type 2– 4), major vascular complications, acute kidney injury (stage 2– 4) and permanent pacemaker implantation, were comparable between the two groups. Multivariable logistic regression analysis did not show MAVD to be an independent negative predictor of device success. At one year, survival was similar between patients with MAVD and those with PAS.
Conclusion: For the bicuspid valve, patients with MAVD had a more challenging anatomy. MAVD patients associated with comparable 30-day clinical outcomes after TAVR compared to PAS patients in patients with BAV.

Keywords: transcatheter aortic valve replacement, mixed aortic valve disease, bicuspid aortic valve, device success, propensity score match

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来源期刊

Clinical Interventions in Aging GERIATRICS & GERONTOLOGY-

CiteScore

6.20

自引率

2.80%

发文量

193

期刊介绍： Clinical Interventions in Aging, is an online, peer reviewed, open access journal focusing on concise rapid reporting of original research and reviews in aging. Special attention will be given to papers reporting on actual or potential clinical applications leading to improved prevention or treatment of disease or a greater understanding of pathological processes that result from maladaptive changes in the body associated with aging. This journal is directed at a wide array of scientists, engineers, pharmacists, pharmacologists and clinical specialists wishing to maintain an up to date knowledge of this exciting and emerging field.