1. Outcome of Patients Undergoing Transcatheter Implantation of Aortic Valve With Previous Mitral Valve Prosthesis (OPTIMAL) Study
- Author
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Israel M. Barbash, Francesco Giannini, Didier Tchetche, Cristina Giannini, Chiara Fraccaro, Giuseppe Tarantini, Giuseppe Bruschi, Scott Lim, Marco Barbanti, Nahid El Faquir, Antonio Colombo, Ariel Finkelstein, Azeem Latib, Ivandito Kuntjoro, Corrado Tamburino, Nicolas M. Van Mieghem, Anna Sonia Petronio, Mohamed Abdel-Wahab, Chiara De Biase, Luca Baldetti, Amit Segev, and Cardiology
- Subjects
Aortic valve ,Male ,medicine.medical_specialty ,Pacemaker, Artificial ,medicine.medical_treatment ,Hemodynamics ,Computed tomography ,030204 cardiovascular system & hematology ,Patient Readmission ,Transcatheter Aortic Valve Replacement ,03 medical and health sciences ,0302 clinical medicine ,Postoperative Complications ,Valve replacement ,Mitral valve ,Medicine ,Humans ,030212 general & internal medicine ,Registries ,Aged ,Retrospective Studies ,Aged, 80 and over ,Heart Failure ,Ejection fraction ,medicine.diagnostic_test ,business.industry ,Gold standard ,Retrospective cohort study ,Aortic Valve Stenosis ,Surgery ,medicine.anatomical_structure ,Heart Valve Prosthesis ,cardiovascular system ,Mitral Valve ,Female ,Cardiology and Cardiovascular Medicine ,business ,Follow-Up Studies - Abstract
Transcatheter aortic valve replacement (TAVR) is the gold standard for severe valvular aortic stenosis in patients at high/prohibitive surgical risk. This procedure has also been used in patients with previous mitral valve (MV) prostheses, with contrasting outcomes reported. The aim of this study is to describe procedural and early outcomes of patients with previous MV prostheses undergoing TAVR.This is a retrospective registry of 154 patients with previous MV prostheses who underwent TAVR across high-volume medical centres at a mean of 11.7 ± 8.4 years after mitral surgery.Mean mitroaortic distance at computed tomography was 9.7 ± 4.8 mm. Procedural success was achieved in 150 (97.4%) patients, with reduction of aortic gradients (42.6 ± 14.2 to 10.0 ± 7.0 mm Hg; P0.001). Device success was achieved in 133 (86.3%) patients. MV prosthesis interference by the TAVR device was observed in 2 patients; in both, the mitroaortic distance was5 mm, with 1 complicated by TAVR prosthesis embolization. Periprocedural complications included 4 (2.6%) cerebrovascular accidents, 10 (6.6%) major vascular complications, 22 (14.4%) severe bleedings, 1 (0.7%) myocardial infarction, and 5 (3.2%) in-hospital deaths (all cases cardiovascular or procedure related). At a median follow-up of 13.5 (interquartile range 1.0 to 36.0) months, 26 (16.9%) deaths occurred; 15 (9.7%) were cardiac related. Late fatal mitral prosthesis thromboses occurred in 2 patients. We recorded a case of fatal hemorrhagic stroke; hospital readmission was observed in 25 (16.2%) patients due to worsening heart failure.TAVR in patients with previous mitral prostheses appears to be safe and feasible, with good hemodynamic results at 30-day and at longer-term follow-up.
- Published
- 2019