The Journal of Practical Medicine >

2023 , Vol. 39 >Issue 19: 2524 - 2528

DOI: https://doi.org/10.3969/j.issn.1006-5725.2023.19.019

Clinical Research

Effect of transcatheter aortic valve implantation on severe aortic stenosis complicated with mitral regurgitation of different degrees

  • Xueya ZHANG ,
  • Yingchun GUO ,
  • Yiqiang YUAN ,
  • Xiaohu WANG ,
  • Xinyi WANG ,
  • Yuxin. CHEN
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  • *.Department of Cardiovascular Medicine，He’nan Provincial Chest Hospital，Zhengzhou 450008，China

Received date: 2023-05-06

  Online published: 2023-11-22

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Abstract

Objective To study the effect of transcatheter aortic valve implantation （TAVI） on severe aortic stenosis （AS） complicated with mitral regurgitation （MR） of different degrees. Methods Retrospectively， 66 patients with severe aortic stenosis and TAVI surgery in Henan Provincial Chest Hospital from April 2020 to June 2022 were included and divided into group A （no regurgitation + mild regurgitation） and group B （moderate + severe regurgitation） according to presence or absence of MR as well as its severity. The changes in cardiac structure and function before and after operation and the effects of TAVI were compared between the two groups. Results The aortic valve peak gradient and aortic valve peak velocity in the two groups after operation were significantly improved compared with those before surgery （P < 0.05）， but there was no statistical difference between the two groups （P > 0.05）. In the moderate and severe mitral regurgitation group， the left atrial diameter ［39.00（37.00，42.00）mm］， left ventricular end diastolic diameter ［47.00（41.00，58.00）mm］， mitral regurgitation ［2.90（2.40，4.70）cm2］ and NT-ProBNP ［2 567.80（1 196.87，3 344.90） pg/mL］ were significantly lower than those before operation ［41.00（38.00，48.00）mm］， ［55.00（44.00，60.00）mm］， ［7.60（5.10，11.00）cm2］， ［4 649.05（2 132.54， 9 333.30）pg/mL］ （P < 0.05）， and LVEF was higher than before surgery ［50.00（42.00，61.00） vs. 45.00 （35.00， 62.00）， P < 0.05］. Conclusion TAVI can be used for the treatment of patients with AS combined with MR of different degrees and it is beneficial for patients with moderate to severe mitral regurgitation as well.

Key words： transcatheter aortic valve implantation; aortic stenosis; mitral regurgitation

Cite this article

Xueya ZHANG , Yingchun GUO , Yiqiang YUAN , Xiaohu WANG , Xinyi WANG , Yuxin. CHEN . Effect of transcatheter aortic valve implantation on severe aortic stenosis complicated with mitral regurgitation of different degrees[J]. The Journal of Practical Medicine, 2023 , 39(19) : 2524 -2528 . DOI: 10.3969/j.issn.1006-5725.2023.19.019

References

1 汪宇鹏.经导管主动脉瓣置换术治疗选择与应用进展［J］.中国现代医学杂志，2023，33（7）：1-6.
2 梁影， 管玉龙. 经导管主动脉瓣置换术临床应用现状及进展［J］. 心肺血管病杂志， 2019， 38（1）：104-108.
3 张俊伟，马俊贤. 经导管自膨式和球囊扩张式主动脉人工瓣膜置入术疗效比较的Meta分析［J］. 实用医学杂志，2017，33（4）：639-642.
4 REARDON M J， VAN MIEGHEM N M， POPMA J J， et al. Surgical or transcatheter aortic-valve replacement in intermediate-risk patients［J］. N Engl J Med， 2017， 376（14）： 1321-1331.
5 MACK M J， LEON M B， THOURANI V H， et al. Transcatheter aortic-valve replacement with a balloon-expandable valve in low-risk patients［J］. N Engl J Med， 2019， 380（18）： 1695-1705.
6 ALEC V， FRIEDHELM B， FABIEN P， et al. 2021 ESC/EACTS Guidelines for the management of valvular heart disease［J］.Eur Heart J， 2021， 43（7）：561-632.
7 KHAN F， OKUNO T， MALEBRANCHE D， et al. Transcatheter aortic valve replacement in patients with mulfivalvular heart disease［J］. JACC Cardiovasc Interv， 2020， 13（13）：1503-1514.
8 MAVROMATIS K， THOURANI V H， STEBBINS A， et al. Transcatheter aortic valve replacement in patients with aortic stenosis and mitralR egurgitation［J］. Ann thorac surg， 2017， 104（6）：1977-1985.
9 FREITAS FERRAZ A B， LERAKIS S， BARBOSA R H， et al. Mitral regurgitation in low-flow，low-gradient aortic stenosis patients undergoing TAVR： insights from the TOPAS-TAVI registry［J］. JACC Cardiovasc Interv， 2020， 13（5）： 567-579. 2.
10 DAVIDSON L J， DAVIDSON C J. Transcatheter treatment of valvular heart disease： A review［J］. Jama， 2021， 325（24）： 2480-2494.
11 赵丹凤，栾永. TAVI手术麻醉进展［J］. 实用医学杂志，2017，33（1）：157-159.
12 LEON M B， SMITH C R， MACK M J， et al. PARTNER 2 Investigators. Transcatheter or surgical aortic-valve replacement in intermediate-risk patients［J］. N Engl J Med， 2016，374（17）：1609-1620.
13 MAKKAR R R， THOURANI V H， MACK M J， et al. PARTNER 2 Investigators. Five-year outcomes of transcatheter or surgical aortic-valve replacement［J］. N Engl J Med， 2020，382（9）：799-809.
14 OTTO C M， NISHIMURA R A， et al. 2020 ACC/AHA guideline for the management of patients with valvular heart disease： A report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines［J］.Thorac Cardiovasc Surg， 2021， 143（5）：e35-e71.
15 周达新， 潘文志， 吴永健， 等. 经导管主动脉瓣置换术中国专家共识 （2020更新版）.［J］ 中国介入心脏病学杂志， 2020， 28（6）： 301-309.
16 NAPPI F， NENNA A， TIMOFEEVA I， et al. Mitral regurgitation after transcatheter aortic valve replacement［J］. J Thorac Dis， 2020， 12（5）：2926-2935.
17 MEDRANDA G A， BRAHMBHATT K， SALHAB K， et al. Predictors and Outcome Impact of Mitral Regurgitation in Transcatheter Aortic Valve Replacement［J］. Cardiovasc Revasc Med， 2021， 32：35-40.
18 DOMINICI C， SALSANO A， NENNA A， et al. Higher preoperative left atrial volume index predicts lack of mitral regurgitation improvement after transcatheter aortic valve replacement［J］. J Cardiovasc Med， 2020， 21（5）： 383-390.
19 MAURI V， KORBER M I， KUHN E， et al. Prognosis of persistent mitral regurgitation in patients undergoing transcatheter aortic valve replacement［J］. Clin Res Cardiol， 2020， 109（10）：1261-1270.
20 BBEN-ASSA E， BINER S， BANAI S， et al. Clinical impact of post procedural mitral regurgitation after transcatheter aortic valve replacement［J］. Int J Cardiol， 2020， 299：215-221.
21 TWING A H， GOKHALE S， SLOSTAD B et a1. Impact of Transcatheter Aortic Valve Implantation Among Patients With Co-existing Mild to Moderate Mitral Regurgitation［J］. Am J Cardiol， 2022， 177： 84-89.
22 MIURA M， YAMAJI K， SHIRAI S， et al. Clinical impact of preprocedural moderate or severe mitral regurgitation on outcomes after transcatheter aortic valve replacement［J］. Can J Cardiol， 2020， 36（7）：1112-1120.
23 ITABASHI Y， SHIBAYAMA K， MIHARA H， et a1. Significant reduction in mitral regurgitation volume is the main contributor for increase in systohc forward flow in patient with functional mitral regurgitation after transcatheter aortic valve replacement：hemodynamic analysis using echocardiography［J］. Echocardiogr， 2015， 32（11）：1621-1627.
24 CORTES C， AMAT SANTOS I J， NOMBELA F L， et al. Mitral regurgitation after transcatheter aortic valve replacement： prognosis， imaging predictors， and potential management［J］. JACC Cardiovasc Interv， 2016， 9（15）： 1603-1614.
25 KIRAMIJYAN S， MAGALHAES M A， KOIFMAN E， et a1. Impact of baseline mitral regurgitation on short-and longterm outcomes following transcatheter aotic valve replacement［J］. Am Heart J， 2016， 178：1927.
26 AMAT SANTOS I J， CORTES C， NOMBELA F L， et a1. Prosthefc mitral surgical valve in transcatheter aortic valve replacement recipients：A multicenter analysis［J］. JACC Cardiovasc Interv， 2017， 10 （19）：1973-1981.
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