Transcatheter Aortic Valve Replacement After Prior Mitral Valve Surgery: Results From the Transcatheter Valve Therapy Registry.
Transcatheter Aortic Valve Replacement After Prior Mitral Valve Surgery: Results From the Transcatheter Valve Therapy Registry.
- 2020
Available online from MWHC library: 1995 - present, Available in print through MWHC library:1999-2007
BACKGROUND: Due to perceived technical challenges, patients with previous surgical mitral valve repair or replacement (SMVR) have been excluded from most transcatheter aortic valve replacement (TAVR) trials. Our objective was to compare the 30-day and 1-year outcomes of TAVR in patients with and without prior SMVR. CONCLUSIONS: Patients with prior SMVR undergoing TAVR had similar 30-day outcomes, slightly higher 1-year mortality, and no increase in early PVL compared to those without previous SMVR. Prior SMVR should not preclude TAVR in appropriately selected patients. Copyright (c) 2019. Published by Elsevier Inc. METHODS: In a retrospective review of the Society of Thoracic Surgeons (STS) and American College of Cardiology (ACC) Transcatheter Valve Therapy (TVT) Registry, we compared 1,097 patients with prior SMVR to 46,327 without prior SMVR who underwent TAVR between November 2011 and September 2015 at 394 U.S. centers. Preoperative characteristics, procedural details, and clinical outcomes were analyzed. RESULTS: Patients with previous SMVR were younger, more often female, and had higher STS Predicted Risk of Mortality (8.6% vs. 6.8%, p<0.001). However, there was no difference in 30-day mortality (4.6% vs. 5.5%, p=0.29), myocardial infarction, stroke, re-intervention, new dialysis, or readmission. Moderate/severe paravalvular leak (PVL) at discharge was also similar (5.8% vs. 4.9%, p=0.34). At 1 year, morbidity was similar but there was a trend toward higher mortality in those with prior SMVR (20.0% vs. 17.5%, p=0.09) that was significant after adjustment (HR 1.18, p=0.04). The type of prior SMVR (repair, bioprosthetic replacement, or mechanical replacement) had no impact on 30-day or 1-year survival.
English
0003-4975
10.1016/j.athoracsur.2019.08.113 [doi] S0003-4975(19)31594-2 [pii]
*Aortic Valve/su [Surgery]
*Heart Valve Diseases/su [Surgery]
*Mitral Valve/su [Surgery]
*Registries
*Transcatheter Aortic Valve Replacement/mt [Methods]
Aged
Aged, 80 and over
Aortic Valve Stenosis/co [Complications]
Aortic Valve Stenosis/mo [Mortality]
Aortic Valve Stenosis/su [Surgery]
Female
Follow-Up Studies
Heart Valve Diseases/co [Complications]
Heart Valve Diseases/mo [Mortality]
Humans
Male
Reoperation
Retrospective Studies
Risk Factors
Survival Rate/td [Trends]
Treatment Outcome
United States/ep [Epidemiology]
MedStar Heart & Vascular Institute
Journal Article
Available online from MWHC library: 1995 - present, Available in print through MWHC library:1999-2007
BACKGROUND: Due to perceived technical challenges, patients with previous surgical mitral valve repair or replacement (SMVR) have been excluded from most transcatheter aortic valve replacement (TAVR) trials. Our objective was to compare the 30-day and 1-year outcomes of TAVR in patients with and without prior SMVR. CONCLUSIONS: Patients with prior SMVR undergoing TAVR had similar 30-day outcomes, slightly higher 1-year mortality, and no increase in early PVL compared to those without previous SMVR. Prior SMVR should not preclude TAVR in appropriately selected patients. Copyright (c) 2019. Published by Elsevier Inc. METHODS: In a retrospective review of the Society of Thoracic Surgeons (STS) and American College of Cardiology (ACC) Transcatheter Valve Therapy (TVT) Registry, we compared 1,097 patients with prior SMVR to 46,327 without prior SMVR who underwent TAVR between November 2011 and September 2015 at 394 U.S. centers. Preoperative characteristics, procedural details, and clinical outcomes were analyzed. RESULTS: Patients with previous SMVR were younger, more often female, and had higher STS Predicted Risk of Mortality (8.6% vs. 6.8%, p<0.001). However, there was no difference in 30-day mortality (4.6% vs. 5.5%, p=0.29), myocardial infarction, stroke, re-intervention, new dialysis, or readmission. Moderate/severe paravalvular leak (PVL) at discharge was also similar (5.8% vs. 4.9%, p=0.34). At 1 year, morbidity was similar but there was a trend toward higher mortality in those with prior SMVR (20.0% vs. 17.5%, p=0.09) that was significant after adjustment (HR 1.18, p=0.04). The type of prior SMVR (repair, bioprosthetic replacement, or mechanical replacement) had no impact on 30-day or 1-year survival.
English
0003-4975
10.1016/j.athoracsur.2019.08.113 [doi] S0003-4975(19)31594-2 [pii]
*Aortic Valve/su [Surgery]
*Heart Valve Diseases/su [Surgery]
*Mitral Valve/su [Surgery]
*Registries
*Transcatheter Aortic Valve Replacement/mt [Methods]
Aged
Aged, 80 and over
Aortic Valve Stenosis/co [Complications]
Aortic Valve Stenosis/mo [Mortality]
Aortic Valve Stenosis/su [Surgery]
Female
Follow-Up Studies
Heart Valve Diseases/co [Complications]
Heart Valve Diseases/mo [Mortality]
Humans
Male
Reoperation
Retrospective Studies
Risk Factors
Survival Rate/td [Trends]
Treatment Outcome
United States/ep [Epidemiology]
MedStar Heart & Vascular Institute
Journal Article