新一代球囊可扩张经导管主动脉瓣置换术后年轻和低风险患者假体-患者不匹配

IF 11.4 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS
Kazuki Suruga MD , Vivek Patel MS , Takashi Nagasaka MD , Yuchao Guo MD , Prateek Madaan MD , Ofir Koren MD , Dhairya Patel MPH , Izabela Harutyunyan MSN , Aakriti Gupta MD , Tarun Chakravarty MD , Wen Cheng MD , Hasan Jilaihawi MD , Mamoo Nakamura MD , Raj R. Makkar MD
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引用次数: 0

摘要

背景在年轻低风险患者中,经导管主动脉瓣置换术(TAVR)后假体-患者失配(PPM)的临床影响尚不清楚。目的:本单中心研究的目的是评估TAVR后严重原生主动脉狭窄(AS)的年轻低危患者PPM的发生率、预测因素和长期影响。方法2015年8月至2022年12月,共3549例患者接受了新一代球囊扩张瓣膜TAVR。其中包括512例年龄小于75岁且胸外科学会评分为<;4%的严重先天性AS患者。对PPM组和非PPM组随访期间的全因死亡率和心血管死亡率或心力衰竭住院率进行比较。PPM是根据Valve学术研究联盟-3标准定义的。结果512例患者中有200例(39.0%)出现sppm, 512例患者中有162例(31.6%)出现中度PPM, 512例患者中有38例(7.4%)出现重度PPM。年龄较小、女性、体表面积较大、无球囊扩张和较小的环面积是PPM的独立预测因子。中位随访时间为1034天(Q1-Q3: 550- 1567天),与非PPM组相比,PPM组的全因死亡率明显更高(HR: 2.55;95% ci: 1.3-5.0;P = 0.007),心血管死亡率(HR: 2.81;95% ci: 1.1-7.5;P = 0.04),心力衰竭住院率(HR: 4.43;95% ci: 2.0-9.9;P & lt;0.001)。结论年轻低风险AS患者TAVR后sppm与较差的临床结果相关,即使是新一代球囊可膨胀瓣膜。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Prosthesis-Patient Mismatch in Young and Low-Risk Patients After Newer Generation Balloon-Expandable Transcatheter Aortic Valve Replacement

Background

The clinical impact of prosthesis-patient mismatch (PPM) after transcatheter aortic valve replacement (TAVR) is not well known in young and low-risk patients.

Objectives

The aim of this single-center study was to evaluate the incidence, predictors, and long-term impact of PPM in young and low-risk patients with severe native aortic stenosis (AS) following TAVR.

Methods

From August 2015 to December 2022, a total of 3,549 patients underwent TAVR with newer generation balloon-expandable valves. Among them, 512 patients with severe native AS who were younger than 75 years and had Society of Thoracic Surgeons scores <4% were included. All-cause and cardiovascular mortality or heart failure hospitalization during follow-up period were compared between the PPM and non-PPM groups. PPM was defined according to the Valve Academic Research Consortium-3 criteria.

Results

PPM was observed in 200 of 512 patients (39.0%), with moderate and severe PPM in 162 of 512 (31.6%) and 38 of 512 (7.4%), respectively. Younger age, female sex, larger body surface area, no balloon postdilation, and smaller annular area were independent predictors of PPM. Over a median follow-up duration of 1,034 days (Q1-Q3: 550-1,567 days), compared with the non-PPM group, the PPM group had significantly higher all-cause mortality (HR: 2.55; 95% CI: 1.3-5.0; P = 0.007), cardiovascular mortality (HR: 2.81; 95% CI: 1.1-7.5; P = 0.04), and heart failure hospitalization (HR: 4.43; 95% CI: 2.0-9.9; P < 0.001).

Conclusions

PPM is associated with worse clinical outcomes in young and low-risk patients with AS after TAVR, even with newer generation balloon-expandable valves.
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来源期刊
JACC. Cardiovascular interventions
JACC. Cardiovascular interventions CARDIAC & CARDIOVASCULAR SYSTEMS-
CiteScore
11.60
自引率
8.80%
发文量
756
审稿时长
4-8 weeks
期刊介绍: JACC: Cardiovascular Interventions is a specialist journal launched by the Journal of the American College of Cardiology (JACC). It covers the entire field of interventional cardiovascular medicine, including cardiac, peripheral, and cerebrovascular interventions. The journal publishes studies that will impact the practice of interventional cardiovascular medicine, including clinical trials, experimental studies, and in-depth discussions by respected experts. To enhance visual understanding, the journal is published both in print and electronically, utilizing the latest technologies.
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