免疫介导的炎症性疾病患者主动脉瓣置换术后生物人工瓣膜失效的差异

Christopher Sefton, Davis Leaphart, Benjamin Klein, Garrett Santini, Aditi Patel, M. Elaine Husni, Patrick Vargo, Eric E. Roselli, Lars Svensson, Amar Krishnaswamy, Samir R. Kapadia, Venu Menon, Umesh N. Khot, Heba Wassif
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摘要

导言:免疫介导的炎症性疾病(IMID)是自身免疫性疾病的一个分支,包括系统性红斑狼疮、类风湿性关节炎和银屑病,正在成为包括瓣膜疾病在内的多种心血管疾病的危险因素。目的:确定IMID是否与外科主动脉瓣置换术(SAVR)和经导管瓣膜置换术(TAVR)后生物人工瓣膜功能衰竭(BVF)的频繁和早期发展有关。方法:对 2000 年至 2022 年期间在克利夫兰诊所接受 SAVR 和 TAVR 患者的连续超声心动图进行评估,以确定术后出现 BVF 的时间。使用 ICD10 编码对有 IMID 和无 IMID 的患者进行分层。采用 Kaplan-Meier 曲线和 cox 比例危险回归分析评估 TAVR 和 SAVR 术后发生 BVF 的差异。结果:共纳入351例TAVR患者(52例IMID患者和299例对照患者)和1961例SAVR患者(300例IMID患者和1661例对照患者)。TAVR后发生BVF的IMID患者和对照组患者分别为12人(23.1%)和21人(7.0%),调整后的危险比为4.02(1.81 - 8.92)。在 IMID 患者中,50% 的患者发生 BVF 的时间较早,在 6.6 年时 IMID 患者就发生了 BVF,而对照组患者则没有达到这一时间(p < 0.001)。SAVR术后,IMID与对照组的BVF发生率和发生时间无明显差异。结论:与对照组相比,IMID 患者在 TAVR 术后发生 BVF 的时间更早,频率更高。IMID患者在考虑进行TAVR时,应将这一风险纳入共同决策中,并在术后进行更频繁的监测。SAVR术后则未出现BVF方面的这些差异。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Differences in bioprosthetic valve failure after aortic valve replacement in patients with immune mediated inflammatory diseases
Introduction: Immune-mediated inflammatory disease (IMID) is a subset of autoimmune diseases including systemic lupus erythematosus, rheumatoid arthritis, and psoriasis that is emerging as a risk factor for many cardiovascular diseases including valvular disease. Objectives: To determine whether IMID is associated with frequent and early development of bioprosthetic valve failure (BVF) after surgical aortic valve replacement (SAVR) and transcatheter valve replacement (TAVR). Methods: Serial echocardiograms for patients who underwent SAVR and TAVR at Cleveland Clinic between 2000 and 2022 were assessed for time to development of BVF after procedure. ICD10 codes were used to stratify to those with and without IMID. Kaplan-Meier curve and cox proportional hazard regression analysis were used to assess for differences in development of BVF after TAVR and SAVR. Results: 351 TAVR patients (52 IMID and 299 controls) and 1961 SAVR patients (300 IMID and 1661 controls) were included. BVF after TAVR occurred in 12 (23.1%) IMID and 21 (7.0%) control patients, respectively, yielding an adjusted hazard ratio of 4.02 (1.81 - 8.92). Time to 50% of patients developing BVF was earlier among IMID, occurring at 6.6 years IMID and not reached in controls (p < 0.001). There were no significant differences in prevalence and time to development of BVF in IMID vs controls after SAVR. Conclusion: After TAVR, BVF occurred earlier and more frequently in patients with IMID than controls. This risk should be included during shared decision making among IMID patients considered for TAVR, and may warrant more frequent monitoring post procedure. These differences in BVF were not seen after SAVR.
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