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Войти в исследования Journal of the American Heart Association · 2025
Prevalence and Management of Multiple Valvular Heart Disease in Patients Undergoing Transcatheter Aortic Valve Replacement: A Multicenter Study on the Impact of Staged Valvular Interventions on Outcomes.
СтатьяМногоцентровое исследованиеПоддержка исследования: вне правительства СШАНазвание и аннотация: Перевод в очереди
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Al-Kassou Baravan, Kapplinghaus Jannik, Meckelburg Caroline, Shamekhi Jasmin, Aksoy Adem, Wienemann Hendrik, Al-Kassou Lara, Zietzer Andreas, Sugiura Atsushi, Tiyerili Vedat, Eckel Clemens, Vogelhuber Johanna, Weber Marcel, Zeus Tobias, Adam Matti, Möllmann Helge, Abdel-Wahab Mohamed, Thiele Holger, Baldus Stephan, Kelm Malte, Bakhtiary Farhad, Nickenig Georg, Zimmer Sebastian
Аннотация
BACKGROUND: Multiple valvular heart disease correlates with poor outcomes following transcatheter aortic valve replacement. Previous studies have focused on mitral regurgitation (MR) or tricuspid regurgitation (TR) individually, without comparing their long-term effects. The impact of staged transcatheter edge-to-edge repair (TEER) remains unclear. We aimed to assess the prevalence and effects of severe multiple valvular heart disease (sMVHD) and evaluate the impact of staged TEER on outcomes.
METHODS: Patients were recruited from 4 transcatheter aortic valve replacement centers. The primary cohort included 2823 patients to evaluate the prevalence of sMVHD. All patients were screened for additional valvular interventions; those undergoing TEER for severe MR (n=147) or TR (n=59) were included.
RESULTS: Concomitant sMVHD was observed in 369 patients, with 208 having severe MR and 161 having severe TR. The 1-year mortality rate was higher in patients with sMVHD compared with the overall cohort (9.0 versus 5.2 per 100 person-years; P<0.01). Severe TR was associated with the highest 1-year mortality rate, followed by severe MR and no or mild multiple valvular heart disease (13.3 versus 6.4 versus 3.9 per 100 person-years; P<0.01). This difference persisted over 5 years (P<0.01). Patients undergoing staged TEER showed a reduced 1-year mortality rate compared with conservative management (4.1 versus 12.1 per 100 person-years; P<0.001). This trend continued over 5 years (P<0.001). Severe TR was independently associated with an increased mortality rate (hazard ratio, 1.79 [95% CI, 1.17-2.74]; P<0.01).
CONCLUSIONS: Persistent sMVHD was associated with an increased mortality rate following transcatheter aortic valve replacement, with severe TR posing a higher risk than severe MR. Staged TEER was associated with improved outcomes and warrants consideration in sMVHD.
METHODS: Patients were recruited from 4 transcatheter aortic valve replacement centers. The primary cohort included 2823 patients to evaluate the prevalence of sMVHD. All patients were screened for additional valvular interventions; those undergoing TEER for severe MR (n=147) or TR (n=59) were included.
RESULTS: Concomitant sMVHD was observed in 369 patients, with 208 having severe MR and 161 having severe TR. The 1-year mortality rate was higher in patients with sMVHD compared with the overall cohort (9.0 versus 5.2 per 100 person-years; P<0.01). Severe TR was associated with the highest 1-year mortality rate, followed by severe MR and no or mild multiple valvular heart disease (13.3 versus 6.4 versus 3.9 per 100 person-years; P<0.01). This difference persisted over 5 years (P<0.01). Patients undergoing staged TEER showed a reduced 1-year mortality rate compared with conservative management (4.1 versus 12.1 per 100 person-years; P<0.001). This trend continued over 5 years (P<0.001). Severe TR was independently associated with an increased mortality rate (hazard ratio, 1.79 [95% CI, 1.17-2.74]; P<0.01).
CONCLUSIONS: Persistent sMVHD was associated with an increased mortality rate following transcatheter aortic valve replacement, with severe TR posing a higher risk than severe MR. Staged TEER was associated with improved outcomes and warrants consideration in sMVHD.