Transcatheter Aortic Valve Replacement After Prior Mitral Valve Surgery: Results From the Transcatheter Valve Therapy Registry.

MedStar author(s):
Citation: Annals of Thoracic Surgery. 109(6):1789-1796, 2020 06.PMID: 31655043Institution: MedStar Heart & Vascular InstituteForm of publication: Journal ArticleMedline article type(s): Journal ArticleSubject headings: *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]Year: 2020Local holdings: Available online from MWHC library: 1995 - present, Available in print through MWHC library:1999-2007ISSN:
  • 0003-4975
Name of journal: The Annals of thoracic surgeryAbstract: 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.All authors: Babaliaros V, Bavaria JE, Ben-Dor I, Carroll JD, Cervantes D, Chris Malaisrie S, Cohen DJ, Forcillo J, Gleason T, Herrmann H, Holmes D, Holper EM, Kapadia S, Kelly JJ, Kirtane A, Kodali S, Leon M, Mack M, Manandhar P, Reardon M, Rogers T, Satler L, Shults C, Szeto WY, Thourani VH, Vemulapalli S, Waksman ROriginally published: Annals of Thoracic Surgery. 2019 Oct 23Fiscal year: FY2020Original title: TAVR After Prior Mitral Valve Surgery: Results from the Transcatheter Valve Therapy Registry.Digital Object Identifier: Date added to catalog: 2019-11-19
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Item type Current library Collection Call number Status Date due Barcode
Journal Article MedStar Authors Catalog Article 31655043 Available 31655043

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.

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