背景:二叶主动脉瓣(BAV)狭窄患者的经导管主动脉瓣置换术(TAVR)在技术上具有挑战性,并且增加了瓣膜旁反流(PVR)的风险。
目的:为了确定发病率,预测因子,Sievers1型BAV狭窄患者TAVR后PVR的临床结果。
方法:纳入24个国际中心接受TAVR的重度Sievers1型BAV狭窄患者,并采用电流代经导管心脏瓣膜(THV)。PVR被分级为无/痕迹,温和,中度,根据超声心动图标准严重。主要不良事件(MAE)的终点,定义为全因死亡的复合物,中风,或者因心力衰竭住院,在最后一次可用的随访中进行了评估。
结果:共纳入946例患者。423例患者发生PVR(44.7%):轻度,中度,387例严重(40.9%),32(3.4%),和4名(0.4%)患者,分别。中度或重度PVR的独立预测因素是较大的虚拟中环(VRR)周长(ORadj1.07,95%CI1.02-1.13),严重的环形或左心室流出道(LVOT)钙化(ORadj5.21,95%CI1.45-18.77),自膨胀阀(ORadj9.01,95%CI2.09-38.86),和有意的超环形THV定位(ORadj3.31,95%CI1.04-10.54)。在中位随访1.3[IQR0.5-2.4]年时,中度或重度PVR与MAE风险增加相关(HRadj2.52,95%CI1.24-5.09).
结论:在Sievers1型BAV狭窄的TAVR和电流生成THV后,约4%的病例发生中度或重度PVR,并与随访期间MAE风险增加相关.
BACKGROUND: Transcatheter aortic valve replacement (TAVR) in patients with bicuspid aortic valve (BAV) stenosis is technically challenging and is burdened by an increased risk of paravalvular regurgitation (PVR).
OBJECTIVE: The aim of this study was to identify the incidence, predictors, and clinical outcomes of PVR after TAVR in Sievers type 1 BAV stenosis.
METHODS: Consecutive patients with Sievers type 1 BAV stenosis undergoing TAVR with current-generation transcatheter heart valves (THVs) in 24 international centers were enrolled. PVR was graded as none/trace, mild, moderate, and severe according to echocardiographic criteria. The endpoint of major adverse events (MAEs), defined as a composite of all-cause death, stroke, or hospitalization for heart failure, was assessed at the last available follow-up.
RESULTS: A total of 946 patients were enrolled. PVR occurred in 423 patients (44.7%)-mild, moderate, and severe in 387 (40.9%), 32 (3.4%), and 4 (0.4%) patients, respectively. Independent predictors of moderate or severe PVR were a larger virtual raphe ring perimeter (adjusted OR: 1.07; 95% CI: 1.02-1.13), severe annular or left ventricular outflow tract calcification (adjusted OR: 5.21; 95% CI: 1.45-18.77), a self-expanding valve (adjusted OR: 9.01; 95% CI: 2.09-38.86), and intentional supra-annular THV positioning (adjusted OR: 3.31; 95% CI: 1.04-10.54). At a median follow-up of 1.3 years (Q1-Q3: 0.5-2.4 years), moderate or severe PVR was associated with an increased risk of MAEs (adjusted HR: 2.52; 95% CI: 1.24-5.09).
CONCLUSIONS: After TAVR with current-generation THVs in Sievers type 1 BAV stenosis, moderate or severe PVR occurred in about 4% of cases and was associated with an increased risk of MAEs during follow-up.