Objectives: The aim of this study was to describe baseline characteristics, and periprocedural and mid-term outcomes of patients undergoing transcatheter mitral valve interventions post-transcatheter aortic valve replacement (TAVR) and examine their clinical benefit. Background: The optimal management of residual mitral regurgitation (MR) post-TAVR is challenging. Methods: This was an international registry of 23 TAVR centers. Results: In total, 106 of 24,178 patients (0.43%) underwent mitral interventions post-TAVR (100 staged, 6 concomitant), most commonly percutaneous edge-to-edge mitral valve repair (PMVR). The median interval post-TAVR was 164 days. Mean age was 79.5 ± 7.2 years, MR was >moderate in 97.2%, technical success was 99.1%, and 30-day device success rate was 88.7%. There were 18 periprocedural complications (16.9%) including 4 deaths. During a median follow-up of 464 days, the cumulative risk for 3-year mortality was 29.0%. MR grade and New York Heart Association (NYHA) functional class improved dramatically; at 1 year, MR was moderate or less in 90.9% of patients (mild or less in 69.1%), and 85.9% of patients were in NYHA functional class I/II. Staged PMVR was associated with lower mortality versus medical treatment (57.5% vs. 30.8%) in a propensity-matched cohort (n = 156), but this was not statistically significant (hazard ratio: 1.75; p = 0.05). Conclusions: For patients who continue to have significant MR, remain symptomatic post-TAVR, and are anatomically suitable for transcatheter interventions, these interventions are feasible, safe, and associated with significant improvement in MR grade and NYHA functional class. These results apply mainly to PMVR. A staged PMVR strategy was associated with markedly lower mortality, but this was not statistically significant. (Transcatheter Treatment for Combined Aortic and Mitral Valve Disease. The Aortic+Mitral TRAnsCatheter Valve Registry [AMTRAC]; NCT04031274)
Transcatheter Treatment of Residual Significant Mitral Regurgitation Following TAVR: A Multicenter Registry / Witberg, G.; Codner, P.; Landes, U.; Brabanti, M.; Valvo, R.; De Backer, O.; Ooms, J. F.; Sievert, K.; El Sabbagh, A.; Jimenez-Quevedo, P.; Brennan, P. F.; Sedaghat, A.; Masiero, G.; Werner, P.; Overtchouk, P.; Watanabe, Y.; Montorfano, M.; Bijjam, V. R.; Hein, M.; Fiorina, C.; Arzamendi, D.; Rodriguez-Gabella, T.; Fernandez-Vazquez, F.; Baz, J. A.; Laperche, C.; Grasso, C.; Branca, L.; Estevez-Loureiro, R.; Benito-Gonzalez, T.; Amat Santos, I. J.; Ruile, P.; Mylotte, D.; Buzzatti, N.; Piazza, N.; Andreas, M.; Tarantini, G.; Sinning, J. -M.; Spence, M. S.; Nombela-Franco, L.; Guerrero, M.; Sievert, H.; Sondergaard, L.; Van Mieghem, N. M.; Tchetche, D.; Webb, J. G.; Kornowski, R.. - In: JACC: CARDIOVASCULAR INTERVENTIONS. - ISSN 1936-8798. - 13:23(2020), pp. 2782-2791. [10.1016/j.jcin.2020.07.014]
Transcatheter Treatment of Residual Significant Mitral Regurgitation Following TAVR: A Multicenter Registry
Montorfano M.;
2020-01-01
Abstract
Objectives: The aim of this study was to describe baseline characteristics, and periprocedural and mid-term outcomes of patients undergoing transcatheter mitral valve interventions post-transcatheter aortic valve replacement (TAVR) and examine their clinical benefit. Background: The optimal management of residual mitral regurgitation (MR) post-TAVR is challenging. Methods: This was an international registry of 23 TAVR centers. Results: In total, 106 of 24,178 patients (0.43%) underwent mitral interventions post-TAVR (100 staged, 6 concomitant), most commonly percutaneous edge-to-edge mitral valve repair (PMVR). The median interval post-TAVR was 164 days. Mean age was 79.5 ± 7.2 years, MR was >moderate in 97.2%, technical success was 99.1%, and 30-day device success rate was 88.7%. There were 18 periprocedural complications (16.9%) including 4 deaths. During a median follow-up of 464 days, the cumulative risk for 3-year mortality was 29.0%. MR grade and New York Heart Association (NYHA) functional class improved dramatically; at 1 year, MR was moderate or less in 90.9% of patients (mild or less in 69.1%), and 85.9% of patients were in NYHA functional class I/II. Staged PMVR was associated with lower mortality versus medical treatment (57.5% vs. 30.8%) in a propensity-matched cohort (n = 156), but this was not statistically significant (hazard ratio: 1.75; p = 0.05). Conclusions: For patients who continue to have significant MR, remain symptomatic post-TAVR, and are anatomically suitable for transcatheter interventions, these interventions are feasible, safe, and associated with significant improvement in MR grade and NYHA functional class. These results apply mainly to PMVR. A staged PMVR strategy was associated with markedly lower mortality, but this was not statistically significant. (Transcatheter Treatment for Combined Aortic and Mitral Valve Disease. The Aortic+Mitral TRAnsCatheter Valve Registry [AMTRAC]; NCT04031274)I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
