Mixed aortic valve disease: association with paravalvular leak and reduced survival after transcatheter aortic valve replacement

被引：2

作者：

Demirel, Caglayan ^{[1
]}

Winter, Max Paul ^{[1
]}

Nitsche, Christian ^{[1
]}

Koschatko, Sophia ^{[1
]}

Jantsch, Charlotte ^{[1
]}

Mascherbauer, Katharina ^{[1
]}

Halavina, Kseniya ^{[1
]}

Heitzinger, Gregor ^{[1
]}

Dona, Carolina ^{[1
]}

Dannenberg, Varius ^{[1
]}

Spinka, Georg ^{[1
]}

Koschutnik, Matthias ^{[1
]}

Andreas, Martin ^{[2
]}

Hengstenberg, Christian ^{[1
]}

Bartko, Philipp E. ^{[1
]}

机构：

[1] Med Univ Vienna, Dept Internal Med 2, Clin Div Cardiol, Waehringer Guertel 18-20A, A-1090 Vienna, Austria

[2] Med Univ Vienna, Dept Cardiac Surg, Vienna, Austria

来源：

EUROPEAN HEART JOURNAL-CARDIOVASCULAR IMAGING | 2024年 / 25卷 / 05期

关键词：

mixed aortic valve disease; transcatheter aortic valve replacement; paravalvular regurgitation after TAVR; NATIVE VALVULAR REGURGITATION; AMERICAN SOCIETY; ECHOCARDIOGRAPHIC-ASSESSMENT; EUROPEAN ASSOCIATION; RECOMMENDATIONS; COLLABORATION; IMPLANTATION; IMPACT;

D O I：

10.1093/ehjci/jeae005

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

Aims Transcatheter aortic valve replacement (TAVR) revolutionized the therapy of severe aortic stenosis (AS) with rising numbers. Mixed aortic valve disease (MAVD) treated by TAVR is gaining more interest, as those patients represent a more complex cohort as compared with isolated AS. However, concerning long-term outcome for this cohort only, limited data are available. The aim of the study is to assess the prevalence of MAVD in TAVR patients, investigate its association with paravalvular regurgitation (PVR), and analyse its impact on long-term mortality after TAVRMethods and results We conducted a registry-based cohort study using the Vienna TAVR registry, enrolling patients who underwent TAVR at Medical University of Vienna between January 2007 and May 2020 with available transthoracic echocardiography before and after TAVR (n = 880). Data analysis included PVR incidence and long-term survival outcomes. A total of 647 (73.52%) out of 880 patients had >= mild aortic regurgitation next to severe AS. MAVD was associated with PVR compared with isolated AS with an odds ratio of 2.06, 95% confidence interval (CI): 1.51-2.81 (P = <0.001). More than mild PVR after TAVR (n = 168 out of 880: 19.09%) was related to higher mortality compared with the absence of PVR with a hazard ratio (HR) of 1.33, 95% CI: 1.05- 1.67 (P = 0.016). MAVD patients developing >= mild PVR after TAVR were also associated with higher mortality compared with the absence of PVR with an HR of 1.30 and 95% CI: 1.04-1.62 (P = 0.022).Conclusion MAVD is prevalent among TAVR patients and presents unique challenges, with increased PVR risk and worse outcomes compared with isolated AS. Long-term survival for MAVD patients, not limited to those developing PVR post-TAVR, is compromised. Earlier intervention before the occurrence of structural myocardial damage or surgical valve replacement might be a potential workaround to improve outcomes.

引用

页码：718 / 726

页数：9

共 29 条

[1] Impact of Prosthetic Valve Regurgitation Assessed by Echocardiography and Magnetic Resonance Imaging on Long-term Clinical Outcomes after TAVR [J].