Baravan Al-Kassou, Jannik Kapplinghaus, Caroline Meckelburg, Jasmin Shamekhi, Adem Aksoy, Hendrik Wienemann, Lara Al-Kassou, Andreas Zietzer, Atsushi Sugiura, Vedat Tiyerili, Clemens Eckel, Johanna Vogelhuber, Marcel Weber, Tobias Zeus, Matti Adam, Helge Möllmann, Mohamed Abdel-Wahab, Holger Thiele, Stephan Baldus, Malte Kelm, Farhad Bakhtiary, Georg Nickenig, Sebastian Zimmer
{"title":"经导管主动脉瓣置换术患者多瓣膜性心脏病的患病率和管理：分阶段瓣膜干预对预后影响的多中心研究","authors":"Baravan Al-Kassou, Jannik Kapplinghaus, Caroline Meckelburg, Jasmin Shamekhi, Adem Aksoy, Hendrik Wienemann, Lara Al-Kassou, Andreas Zietzer, Atsushi Sugiura, Vedat Tiyerili, Clemens Eckel, Johanna Vogelhuber, Marcel Weber, Tobias Zeus, Matti Adam, Helge Möllmann, Mohamed Abdel-Wahab, Holger Thiele, Stephan Baldus, Malte Kelm, Farhad Bakhtiary, Georg Nickenig, Sebastian Zimmer","doi":"10.1161/JAHA.124.040150","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Multiple valvular heart disease correlates with poor outcomes following transcatheter aortic valve replacement. Previous studies have focused on mitral regurgitation (MR) or tricuspid regurgitation (TR) individually, without comparing their long-term effects. The impact of staged transcatheter edge-to-edge repair (TEER) remains unclear. We aimed to assess the prevalence and effects of severe multiple valvular heart disease (sMVHD) and evaluate the impact of staged TEER on outcomes.</p><p><strong>Methods: </strong>Patients were recruited from 4 transcatheter aortic valve replacement centers. The primary cohort included 2823 patients to evaluate the prevalence of sMVHD. All patients were screened for additional valvular interventions; those undergoing TEER for severe MR (n=147) or TR (n=59) were included.</p><p><strong>Results: </strong>Concomitant sMVHD was observed in 369 patients, with 208 having severe MR and 161 having severe TR. The 1-year mortality rate was higher in patients with sMVHD compared with the overall cohort (9.0 versus 5.2 per 100 person-years; <i>P</i><0.01). Severe TR was associated with the highest 1-year mortality rate, followed by severe MR and no or mild multiple valvular heart disease (13.3 versus 6.4 versus 3.9 per 100 person-years; <i>P</i><0.01). This difference persisted over 5 years (<i>P</i><0.01). Patients undergoing staged TEER showed a reduced 1-year mortality rate compared with conservative management (4.1 versus 12.1 per 100 person-years; <i>P</i><0.001). This trend continued over 5 years (<i>P</i><0.001). Severe TR was independently associated with an increased mortality rate (hazard ratio, 1.79 [95% CI, 1.17-2.74]; <i>P</i><0.01).</p><p><strong>Conclusions: </strong>Persistent sMVHD was associated with an increased mortality rate following transcatheter aortic valve replacement, with severe TR posing a higher risk than severe MR. Staged TEER was associated with improved outcomes and warrants consideration in sMVHD.</p>","PeriodicalId":54370,"journal":{"name":"Journal of the American Heart Association","volume":" ","pages":"e040150"},"PeriodicalIF":5.0000,"publicationDate":"2025-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Prevalence and Management of Multiple Valvular Heart Disease in Patients Undergoing Transcatheter Aortic Valve Replacement: A Multicenter Study on the Impact of Staged Valvular Interventions on Outcomes.\",\"authors\":\"Baravan Al-Kassou, Jannik Kapplinghaus, Caroline Meckelburg, Jasmin Shamekhi, Adem Aksoy, Hendrik Wienemann, Lara Al-Kassou, Andreas Zietzer, Atsushi Sugiura, Vedat Tiyerili, Clemens Eckel, Johanna Vogelhuber, Marcel Weber, Tobias Zeus, Matti Adam, Helge Möllmann, Mohamed Abdel-Wahab, Holger Thiele, Stephan Baldus, Malte Kelm, Farhad Bakhtiary, Georg Nickenig, Sebastian Zimmer\",\"doi\":\"10.1161/JAHA.124.040150\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Multiple valvular heart disease correlates with poor outcomes following transcatheter aortic valve replacement. Previous studies have focused on mitral regurgitation (MR) or tricuspid regurgitation (TR) individually, without comparing their long-term effects. The impact of staged transcatheter edge-to-edge repair (TEER) remains unclear. We aimed to assess the prevalence and effects of severe multiple valvular heart disease (sMVHD) and evaluate the impact of staged TEER on outcomes.</p><p><strong>Methods: </strong>Patients were recruited from 4 transcatheter aortic valve replacement centers. The primary cohort included 2823 patients to evaluate the prevalence of sMVHD. All patients were screened for additional valvular interventions; those undergoing TEER for severe MR (n=147) or TR (n=59) were included.</p><p><strong>Results: </strong>Concomitant sMVHD was observed in 369 patients, with 208 having severe MR and 161 having severe TR. The 1-year mortality rate was higher in patients with sMVHD compared with the overall cohort (9.0 versus 5.2 per 100 person-years; <i>P</i><0.01). Severe TR was associated with the highest 1-year mortality rate, followed by severe MR and no or mild multiple valvular heart disease (13.3 versus 6.4 versus 3.9 per 100 person-years; <i>P</i><0.01). This difference persisted over 5 years (<i>P</i><0.01). Patients undergoing staged TEER showed a reduced 1-year mortality rate compared with conservative management (4.1 versus 12.1 per 100 person-years; <i>P</i><0.001). This trend continued over 5 years (<i>P</i><0.001). Severe TR was independently associated with an increased mortality rate (hazard ratio, 1.79 [95% CI, 1.17-2.74]; <i>P</i><0.01).</p><p><strong>Conclusions: </strong>Persistent sMVHD was associated with an increased mortality rate following transcatheter aortic valve replacement, with severe TR posing a higher risk than severe MR. Staged TEER was associated with improved outcomes and warrants consideration in sMVHD.</p>\",\"PeriodicalId\":54370,\"journal\":{\"name\":\"Journal of the American Heart Association\",\"volume\":\" \",\"pages\":\"e040150\"},\"PeriodicalIF\":5.0000,\"publicationDate\":\"2025-06-17\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of the American Heart Association\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1161/JAHA.124.040150\",\"RegionNum\":1,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2025/6/5 0:00:00\",\"PubModel\":\"Epub\",\"JCR\":\"Q1\",\"JCRName\":\"CARDIAC & CARDIOVASCULAR SYSTEMS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of the American Heart Association","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1161/JAHA.124.040150","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/6/5 0:00:00","PubModel":"Epub","JCR":"Q1","JCRName":"CARDIAC & CARDIOVASCULAR SYSTEMS","Score":null,"Total":0}
引用次数: 0
摘要
背景：多瓣膜性心脏病与经导管主动脉瓣置换术后的不良预后相关。以前的研究主要集中在二尖瓣反流（MR）或三尖瓣反流（TR）上，没有比较它们的长期影响。分期经导管边缘到边缘修复（TEER）的影响尚不清楚。我们旨在评估严重多瓣膜性心脏病（sMVHD）的患病率和影响，并评估分期TEER对预后的影响。方法：从4个经导管主动脉瓣置换术中心招募患者。主要队列包括2823例患者，以评估sMVHD的患病率。对所有患者进行额外的瓣膜干预筛查；包括因严重MR （n=147）或TR （n=59）接受TEER治疗的患者。结果：在369例患者中观察到伴有sMVHD，其中208例患有严重MR， 161例患有严重TR。与整体队列相比，sMVHD患者的1年死亡率更高(9.0 vs 5.2 / 100人年；结论：持续性sMVHD与经导管主动脉瓣置换术后死亡率增加相关，严重的TR比严重的mr具有更高的风险，分期TEER与sMVHD的预后改善相关，值得考虑。
Prevalence and Management of Multiple Valvular Heart Disease in Patients Undergoing Transcatheter Aortic Valve Replacement: A Multicenter Study on the Impact of Staged Valvular Interventions on Outcomes.
Background: Multiple valvular heart disease correlates with poor outcomes following transcatheter aortic valve replacement. Previous studies have focused on mitral regurgitation (MR) or tricuspid regurgitation (TR) individually, without comparing their long-term effects. The impact of staged transcatheter edge-to-edge repair (TEER) remains unclear. We aimed to assess the prevalence and effects of severe multiple valvular heart disease (sMVHD) and evaluate the impact of staged TEER on outcomes.
Methods: Patients were recruited from 4 transcatheter aortic valve replacement centers. The primary cohort included 2823 patients to evaluate the prevalence of sMVHD. All patients were screened for additional valvular interventions; those undergoing TEER for severe MR (n=147) or TR (n=59) were included.
Results: Concomitant sMVHD was observed in 369 patients, with 208 having severe MR and 161 having severe TR. The 1-year mortality rate was higher in patients with sMVHD compared with the overall cohort (9.0 versus 5.2 per 100 person-years; P<0.01). Severe TR was associated with the highest 1-year mortality rate, followed by severe MR and no or mild multiple valvular heart disease (13.3 versus 6.4 versus 3.9 per 100 person-years; P<0.01). This difference persisted over 5 years (P<0.01). Patients undergoing staged TEER showed a reduced 1-year mortality rate compared with conservative management (4.1 versus 12.1 per 100 person-years; P<0.001). This trend continued over 5 years (P<0.001). Severe TR was independently associated with an increased mortality rate (hazard ratio, 1.79 [95% CI, 1.17-2.74]; P<0.01).
Conclusions: Persistent sMVHD was associated with an increased mortality rate following transcatheter aortic valve replacement, with severe TR posing a higher risk than severe MR. Staged TEER was associated with improved outcomes and warrants consideration in sMVHD.
期刊介绍：
As an Open Access journal, JAHA - Journal of the American Heart Association is rapidly and freely available, accelerating the translation of strong science into effective practice.
JAHA is an authoritative, peer-reviewed Open Access journal focusing on cardiovascular and cerebrovascular disease. JAHA provides a global forum for basic and clinical research and timely reviews on cardiovascular disease and stroke. As an Open Access journal, its content is free on publication to read, download, and share, accelerating the translation of strong science into effective practice.
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