2026 年第 8 期 第 21 卷

重度主动脉瓣狭窄合并中重度功能性二尖瓣反流患者经导管主动脉瓣置换术后二尖瓣反流转归及影响因素研究

Study on the evolution and influencing factors of mitral regurgitation after transcatheter aortic valve replacement in patients with severe aortic stenosis combined with moderate-to-severe functional mitral regurgitation

作者：吴佳媛刘金凤李晓明吴山张纯

英文作者：Wu Jiayuan Liu Jinfeng Li Xiaoming Wu Shan Zhang Chun

单位：首都医科大学附属北京安贞医院介入超声科，北京100029

英文单位：Department of Interventional Ultrasound Beijing Anzhen Hospital Capital Medical University Beijing 100029 China

关键词：主动脉瓣狭窄；经导管主动脉瓣置换术；二尖瓣反流

英文关键词：Aorticstenosis;Transcatheteraorticvalvereplacement;Mitralregurgitation

• 摘要：

• 目的 探讨重度主动脉瓣狭窄合并中重度功能性二尖瓣反流（FMR）患者经导管主动脉瓣置换术（TAVR）后二尖瓣反流（MR）的转归及影响因素。方法 回顾性分析2023年1月至2025年1月在首都医科大学附属北京安贞医院行TAVR的重度主动脉瓣狭窄合并中重度FMR的患者共71例。根据术后6个月MR程度较术前FMR是否改善分为MR改善组（51例）与MR未改善组（20例）。比较2组患者合并症情况、术前超声参数等指标，对有统计学意义的指标纳入Logistic回归分析得到重度主动脉瓣狭窄合并中重度FMR患者TAVR后MR未改善的影响因素。结果 MR未改善组与MR改善组合并冠心病（冠状动脉粥样硬化性心脏病）比例、术前左心房内径、术前左心室舒张末期容积、术前左心室收缩末期容积比较，差异均有统计学意义（均P＜0.05）。多因素Logistic回归分析结果显示，合并冠心病（比值比=0.146，95%置信区间：0.040～0.533，P=0.004）、左心房内径（比值比=1.155，95%置信区间：1.042～1.280，P=0.006）是MR改善的影响因素。结论 术前合并冠心病是重度AS合并中重度FMR患者TAVR后MR改善的影响因素，左心房增大为其术后MR未改善的影响因素。

• Objective To investigate the evolution and influencing factors of mitral regurgitation (MR) after transcatheter aortic valve replacement (TAVR) in patients with severe aortic stenosis combined with moderate-to-severe functional mitral regurgitation (FMR). Methods A total of 71 patients with severe aortic stenosis complicated with moderate-to-severe FMR who underwent TAVR at Beijing Anzhen Hospital, Capital Medical University from January 2023 to January 2025 were retrospectively analyzed. According to whether the degree of MR was improved at 6 months after operation compared with preoperative FMR, patients were divided into MR improvement group (51 cases) and non-improvement group (20 cases). Comorbidities, preoperative ultrasonic parameters and other indicators were compared between the two groups. Indicators with statistical significance were included in Logistic regression analysis to identify the influencing factors for unimproved MR after TAVR in patients with severe aortic stenosis combined with moderate-to-severe FMR. Results There were statistically significant differences between the MR non-improvement group and MR improvement group in the proportion of combined coronary atherosclerotic heart disease, preoperative left atrial diameter, preoperative left ventricular end-diastolic volume and preoperative left ventricular end-systolic volume (all P＜0.05). Multivariate Logistic regression analysis showed that combined coronary atherosclerotic heart disease (odds ratio=0.146, 95% confidence interval: 0.040-0.533, P=0.004) and left atrial diameter (odds ratio=1.155, 95% confidence interval: 1.042-1.280, P=0.006) were influencing factors for MR improvement. Conclusion Preoperative combined coronary atherosclerotic heart disease is a favorable factor for MR improvement after TAVR in patients with severe aortic stenosis combined with moderate-to-severe FMR, while enlarged left atrium is a risk factor for persistent postoperative MR.