Progression and Prognosis of Paravalvular Regurgitation After Transcatheter Aortic Valve Implantation

Abstract Background: The impact of paravalvular regurgitation (PVR) following transcatheter aortic valve implantation (TAVI) remains uncertain. Objective: To evaluate the impact of PVR on mortality and hospital readmission one year after TAVI. Methods: Between January 2009 and June 2015, a total of 251 patients underwent TAVI with three different prostheses at two cardiology centers. Patients were assessed according to PVR severity after the procedure. Results: PVR was classified as absent/trace or mild in 92.0% (n = 242) and moderate/severe in 7.1% (n = 18). The moderate/severe PVR group showed higher levels of aortic calcification (22% vs. 6%, p = 0.03), higher serum creatinine (1.5 ± 0.7 vs. 1.2 ± 0.4 mg/dL, p = 0.014), lower aortic valve area (0.6 ± 0.1 vs. 0.7 ± 0.2 cm2, p = 0.05), and lower left ventricular ejection fraction (49.2 ± 14.8% vs. 58.8 ± 12.1%, p = 0.009). Patients with moderate/severe PVR had more need for post-dilatation (p = 0.025) and use of larger-diameter balloons (p = 0.043). At one year, all-cause mortality was similar in both groups (16.7% vs. 12%, p = 0.08), as well as rehospitalization (11.1% vs. 7.3%, p = 0.915). PVR grade significantly reduced throughout the first year after the procedure (p < 0.01). The presence of moderate/severe PVR was not associated with higher one-year mortality rates (HR: 0.76, 95% CI: 0.27-2.13, p = 0.864), rehospitalization (HR: 1.08, 95% CI: 0.25-4.69, p=0.915), or composite outcome (HR: 0.77, 95% CI: 0.28-2.13, p = 0.613). Conclusion: In this sample, moderate/severe PVR was not a predictor of long-term mortality or rehospitalization. (Arq Bras Cardiol. 2017; [online].ahead print, PP.0-0)

研究背景：经导管主动脉瓣植入术（transcatheter aortic valve implantation, TAVI）后并发的瓣周漏（paravalvular regurgitation, PVR），其临床影响仍未明确。
研究目的：评估TAVI术后瓣周漏对患者术后1年死亡率与住院再入院率的影响。
研究方法：2009年1月至2015年6月期间，两家心脏中心共251名患者接受了三种不同人工瓣膜的TAVI手术，术后根据瓣周漏严重程度对患者进行分组评估。
研究结果：92.0%（n=242）的患者术后瓣周漏为无/微量或轻度，仅7.1%（n=18）为中度/重度。中度/重度瓣周漏组患者的主动脉钙化比例更高（22% vs. 6%，p=0.03）、血清肌酐水平更高（1.5±0.7 vs. 1.2±0.4 mg/dL，p=0.014）、主动脉瓣面积更小（0.6±0.1 vs. 0.7±0.2 cm²，p=0.05）、左心室射血分数更低（49.2±14.8% vs. 58.8±12.1%，p=0.009）。该组患者更需要接受术后球囊扩张（p=0.025），且更常使用更大直径的球囊（p=0.043）。术后1年随访时，两组患者的全因死亡率（16.7% vs. 12%，p=0.08）与再住院率（11.1% vs. 7.3%，p=0.915）均无显著差异。术后1年内，患者的瓣周漏分级显著降低（p<0.01）。进一步分析显示，中度/重度瓣周漏与更高的1年全因死亡率（风险比HR:0.76，95%置信区间CI:0.27-2.13，p=0.864）、再住院率（HR:1.08，95%CI:0.25-4.69，p=0.915）或复合终点（HR:0.77，95%CI:0.28-2.13，p=0.613）均无显著关联。
研究结论：本研究队列中，中度/重度瓣周漏并非长期死亡率或再住院率的预测因素。（《Arq Bras Cardiol》2017; [网络版]预印, 页码0-0）