经导管主动脉瓣置换治疗单纯性重度主动脉瓣反流合并不同程度肺动脉高压短期结局研究

目的 探讨经导管主动脉瓣置换术（transcatheter aortic valve replacement，TAVR）治疗单纯性重度主动脉瓣关闭不全（aortic regurgitation，AR）合并肺动脉高压（pulmonary artery hypertension, PAH）的短期预后。方法 回顾性分析2021年6月至2022年12月复旦大学附属中山医院收治的29例接受TAVR治疗的单纯性重度AR合并PAH患者的病例资料，根据患者超声心动图测得的肺动脉收缩压（systolic pulmonary artery pressure, SPAP），将患者分为轻中度PAH组（35≤SPAP＜ 50 mmHg，n＝18）和重度PAH组（SPAP≥50 mmHg，n＝11），收集2组患者基线信息、术中影像学资料及术后随访信息。结果 相比于轻中度PAH组，重度PAH组心功能Ⅲ、Ⅳ级占比较高（100% vs 61%, P＝0.018）、脑钠肽较高［（2 820.35±1 762.82） vs （1 241.09±1 999.86）mg/mL, P＝0.040］、左心室射血分数较低［（45.64±10.24）% vs （54.61±11.36）%, P＝0.042］、二尖瓣中重度反流及三尖瓣中重度反流占比更高（73% vs 33%，P＝0.039；82% vs 33%，P＝0.011）。TAVR术后，PAH患者的AR在术后1 d及术后1个月均显著改善（P＜0.001），SPAP均显著下降（P＜0.001），重度PAH组三尖瓣反流程度显著下降（P＝0.009）。在院期间及随访1个月结果发现，AR合并不同程度PAH的患者在术后1 d及术后1个月内无全因死亡及心源性死亡事件的发生。其中，有5.56%重度AR合并轻中度PAH患者与9.09%合并重度PAH的患者在术后1 d和1个月分别发生中重度瓣周漏，中重度AR的占比分别为5.56%和9.09%。2组术后不良事件差异无统计学意义。结论 TAVR治疗单纯性重度AR合并PAH是安全有效的，能够改善AR并且降低肺动脉压力。

Transcatheter aortic valve replacement for pure severe aortic regurgitation combined with varying degrees of pulmonary hypertension: a short-term outcome study

Abstract] Background & Objective: In recent years, transcatheter aortic valve replacement (TAVR) has become an important treatment for pure severe aortic regurgitation (AR), but it has been performed less frequently because of its difficulty. Therefore, the aim of this study was to investigate the short-term prognosis of TAVR for pure severe AR combined with PAH and to provide a basis for the clinical management of this group of patients. Methods: A retrospective analysis of 29 patients with pure severe AR combined with PAH treated with TAVR from June 2021 to December 2022 at Zhongshan Hospital, Fudan University. Information on baseline, intraoperative imaging and postoperative follow-up was collected. Results: A total of 29 patients with simple severe AR with TAVR were enrolled, including 18 patients in the group with mild to moderate PAH and 11 patients in the group with severe PAH. Compared to patients who had mild to moderate PAH with AR, the group with severe PAH had a higher percentage of cardiac function class 3 or 4 (100% vs. 61, P=0.0018) and a higher BNP level(2820.35±1762.82 vs. 1241.09±1999.86, P=0.040). Imaging revealed a lower LVEF in the group with severe PAH (45.64± 10.24 vs. 54.61±11.36, P=0.042) and a higher proportion of moderate to severe mitral regurgitation and tricuspid regurgitation (respectively: moderate to severe mitral regurgitation: 73% vs. 33%, P=0.039; moderate to severe tricuspid regurgitation: 82% vs. 33%, P=0.011). After TAVR, patients with pulmonary hypertension had a significant improvement in AR at 1 day and 1 month postoperatively (p<0.001), a significant decrease in SPAP at 1 day and 1 month postoperatively (p<0.001), and a significant decrease in the degree of tricuspid regurgitation in the group with severe AR combined with severe PAH (p=0.009). Patients with AR combined with varying degrees of PAH were found to be free of all-cause mortality and cardiac mortality at 1 day and 1 month postoperatively during the hospital stay and at 1-month follow-up. Of these, 6% of patients with severe AR combined with mild to moderate PAH versus 9% of patients with severe PAH combined were found to have moderate perivalvular leaks at one day and one month postoperatively, and the proportion of patients with moderate to severe postoperative AR was 5.6% and 9.1%, respectively. Conclusion: TAVR is safe and effective in the treatment of simple severe AR combined with PAH, improving AR and reducing pulmonary artery pressure, with no significant difference in the incidence of postoperative adverse events between the two groups.