Minerva cardiology and angiology · 2025
Evolution and long-term impact of concomitant valvulopathies in patients undergoing transcatheter aortic valve implantation.
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Malara Silvia, Burzotta Francesco, Graziani Francesca, Bianchini Francesco, Scorza Valentina, Romagnoli Enrico, Aurigemma Cristina, Locorotondo Gabriella, Lillo Rosa, Meucci Maria C, Pavone Natalia, Nesta Marialisa, Bruno Piergiorgio, Lombardo Antonella, Trani Carlo
Аннотация
BACKGROUND: Multiple valvular heart disease (M-VHD) is a common condition, often involving aortic stenosis (AS) plus a mitral or tricuspid valve disease. We aim to evaluate the evolution and prognostic impact of M-VHD in patients undergoing transcatheter aortic valve implantation (TAVI).
METHODS: A retrospective cohort study was conducted on patients who underwent TAVI in a tertiary care center between January 2016 and December 2022. Echocardiography was performed before and after TAVI. The primary endpoint was the composite of all-cause mortality and cardiovascular hospitalizations during follow-up.
RESULTS: A total of 159 patients (88 women; mean [SD] age, 80.8 [7.8] years) with severe AS and M-VHD were identified. Seventy-two (45.3%) had mitral regurgitation, 69 (43.4%) had tricuspid regurgitation, and 18 (11.3%) had mitral stenosis. After TAVI, 77 patients (48.4%) experienced an improvement of the concomitant valve disease, while 82 did not. Female gender (OR:0.25, 95%CI:0.11-0.56, P<0.001), pacemaker implantation (OR:0.37, 95%CI:0.14-0.98, P=0.046) and rheumatic etiology (OR:0.25, 95%CI:0.09-0.74, P=0.012) were negatively associated with improvement. At a median follow-up of 31 months (26-51), patients with no improvement had an increased occurrence of the composite endpoint compared to their counterparties, (P=0.028). On multivariable analysis, NYHA class III/IV (HR:2.04, 95%CI:1.02-4.08, P=0.044) and creatinine (HR:1.43, 95%CI:1.06-1.94, P=0.019) were associated with a higher risk of the endpoint, while the improvement of concomitant valve disease emerged as protective factor (HR:0.46, 95%CI:0.25-0.85, P=0.013).
CONCLUSIONS: Concomitant valve disease improved in roughly half of M-VHD patients after TAVI. Patients with post-TAVI improvement of the second valve lesion had better clinical outcomes at long-term follow-up.
METHODS: A retrospective cohort study was conducted on patients who underwent TAVI in a tertiary care center between January 2016 and December 2022. Echocardiography was performed before and after TAVI. The primary endpoint was the composite of all-cause mortality and cardiovascular hospitalizations during follow-up.
RESULTS: A total of 159 patients (88 women; mean [SD] age, 80.8 [7.8] years) with severe AS and M-VHD were identified. Seventy-two (45.3%) had mitral regurgitation, 69 (43.4%) had tricuspid regurgitation, and 18 (11.3%) had mitral stenosis. After TAVI, 77 patients (48.4%) experienced an improvement of the concomitant valve disease, while 82 did not. Female gender (OR:0.25, 95%CI:0.11-0.56, P<0.001), pacemaker implantation (OR:0.37, 95%CI:0.14-0.98, P=0.046) and rheumatic etiology (OR:0.25, 95%CI:0.09-0.74, P=0.012) were negatively associated with improvement. At a median follow-up of 31 months (26-51), patients with no improvement had an increased occurrence of the composite endpoint compared to their counterparties, (P=0.028). On multivariable analysis, NYHA class III/IV (HR:2.04, 95%CI:1.02-4.08, P=0.044) and creatinine (HR:1.43, 95%CI:1.06-1.94, P=0.019) were associated with a higher risk of the endpoint, while the improvement of concomitant valve disease emerged as protective factor (HR:0.46, 95%CI:0.25-0.85, P=0.013).
CONCLUSIONS: Concomitant valve disease improved in roughly half of M-VHD patients after TAVI. Patients with post-TAVI improvement of the second valve lesion had better clinical outcomes at long-term follow-up.