Subclinical Structural Valve Degeneration in Young Patients With Bioprosthetic Aortic Valves,The Annals of Thoracic Surgery

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Subclinical Structural Valve Degeneration in Young Patients With Bioprosthetic Aortic Valves
The Annals of Thoracic Surgery ( IF 3.6 ) Pub Date : 2021-03-19 , DOI: 10.1016/j.athoracsur.2020.07.021
Edward D Percy ₁ , Morgan Harloff ₁ , Sameer Hirji ₁ , Alexandra Malarczyk ₁ , Olena Cherkasky ₁ , Farhang Yazdchi ₁ , Siobhan McGurk ₁ , Prem Shekar ₁ , Tsuyoshi Kaneko ₁

Affiliation

Background

Bioprosthetic structural valve degeneration (SVD) has previously been a clinical diagnosis, but subclinical changes have been increasingly recognized in transcatheter valves. The significance of subclinical SVD after surgical aortic valve replacement (SAVR), however, is not well understood. The purpose of this study was to characterize the incidence and outcomes of subclinical SVD in young patients after SAVR.

Methods

Patients aged ≤65 years who underwent bioprosthetic SAVR between January 2002 and June 2018 at a single institution were included. Endocarditis cases and those with in-hospital mortality were excluded. All available longitudinal postoperative echocardiograms were reviewed. Subclinical SVD was defined as an increase in mean transvalvular gradient of at least 10 mm Hg and/or new onset of mild intraprosthetic regurgitation or increase by at least 1 grade, compared with baseline postoperative echocardiogram.

Results

Overall, 822 unique SAVR cases were included. Over the study period, 356 (43.3%) patients developed subclinical SVD. Only 21.5% of those with subclinical SVD progressed to clinical SVD or to repeat aortic valve procedures. In those with progression, the first signs of SVD occurred significantly earlier than in those whose changes remained stable (11 months vs 23 months; P = .036). Anticoagulation did not impact the development or progression of subclinical SVD. There was no difference in long-term survival for those who did or did not develop subclinical SVD.

Conclusions

Subclinical SVD occurred in a large proportion of young patients undergoing bioprosthetic SAVR. Despite its high prevalence, subclinical SVD was not associated with decreased survival or repeat procedures.

中文翻译：

年轻的生物人工主动脉瓣患者亚临床结构瓣膜变性

背景

生物假体结构瓣膜变性（SVD）以前是临床诊断，但是亚临床变化已在经导管瓣膜中得到越来越多的认可。但是，对外科主动脉瓣置换术（SAVR）后亚临床SVD的重要性了解甚少。这项研究的目的是表征SAVR后年轻患者亚临床SVD的发生率和结局。

方法

纳入2002年1月至2018年6月间在单一机构接受生物修复SAVR的≤65岁的患者。心内膜炎病例和院内死亡病例被排除在外。回顾了所有可用的纵向术后超声心动图。亚临床SVD被定义为与基线术后超声心动图相比，平均经瓣梯度增加至少10 mm Hg和/或轻度假体内反流新发作或增加至少1级。

结果

总体而言，包括了822个独特的SAVR案例。在研究期间，有356名（43.3％）患者发展了亚临床SVD。亚临床SVD患者中只有21.5％的患者发展为临床SVD或重复主动脉瓣手术。在有进展的患者中，SVD的最初体征比那些保持稳定的患者显着更早出现（11个月对23个月；P = .036）。抗凝治疗不会影响亚临床SVD的发生或发展。有或没有发展亚临床SVD的人的长期存活率没有差异。