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Technique and Patient Selection Criteria of Right Anterior Mini-Thoracotomy for Minimal Access Aortic Valve Replacement
Published on: March 26, 2018
Outcomes of Transcatheter Aortic Valve Replacement in Patients With Moderate Mixed Aortic Valve Disease
Yu Tang1, Xue-Chen Qiao2, Meng-Yun Yan2
1Department of Cardiology, West China Hospital, Sichuan University, Chengdu, PR China; Cardiac Structure and Function Research Key Laboratory of Sichuan Province, West China Hospital, Sichuan University, Chengdu, PR China; Laboratory of Cardiac Structure and Function, Institute of Cardiovascular Diseases, West China Hospital, Sichuan University, Chengdu, PR China.
Abstract:
The clinical impact of transcatheter aortic valve replacement (TAVR) in patients with moderate mixed aortic valve disease (MMAVD)-characterized by the coexistence of moderate aortic stenosis (AS) and aortic regurgitation (AR)-remains unclear, as current evidence primarily focuses on isolated severe AS. This study aimed to compare outcomes of TAVR between patients with MMAVD and those with isolated severe AS. Between January 2019 and June 2024, 848 patients who underwent TAVR at our center were identified for analysis, including 75 with MMAVD and 773 with isolated severe AS. To minimize confounding, 73 MMAVD patients were matched with 264 isolated AS patients using 1:4 propensity score matching for comparative analysis. The primary endpoint was all-cause mortality; secondary endpoints included heart failure rehospitalization, left ventricular (LV) reverse remodeling, and procedural complications. Continuous variables were compared using independent samples t-tests, categorical variables using chi-square or Fisher's exact tests, and survival using Kaplan-Meier curves with log-rank tests. At baseline, MMAVD patients exhibited greater LV dilation (LV end-diastolic diameter [LVEDD]: 56.07±9.04 vs 50.68±7.70, p < 0.001) and hypertrophy (LV mass index [LVMI]: 163.68±50.17 vs 151.59±44.38, p = 0.026). Post-TAVR, MMAVD showed superior reverse remodeling (ΔLVEDD: -7.18±9.75 vs -2.52±7.64, p < 0.001), though LVEF recovery was comparable (ΔLVEF: 5.47±13.98 vs 6.88±15.20, p = 0.52). Survival rates were similar (log-rank p = 0.370), but MMAVD had higher 1-year heart failure rehospitalization (5.97% vs 0.96%, p = 0.032). In conclusion, TAVR with self-expandable valves yields comparable survival in MMAVD and isolated AS, with more pronounced reverse remodeling in MMAVD despite advanced baseline disease.
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