1. Transcatheter Mitral Valve Replacement for Degenerated Bioprosthetic Valves and Failed Annuloplasty Rings
- Author
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Marco Ancona, Masahiko Asami, Tarun Chakravarty, Victoria Delgado, Joachim Schofer, Stephan Ensminger, James E. Davies, Michael J. Reardon, Antonio Colombo, Rajiv Rampat, Thomas Pilgrim, Florian Deuschl, Jeroen J. Bax, Daniel J. Blackman, Lena Eschenbach, Harindra C. Wijeysundera, Saibal Kar, Niklas Schofer, Ermela Yzeiraj, Buntaro Fujita, Luis Nombela-Franco, Abhijeet Dhoble, Raj Makkar, Francesco Maisano, Horst Sievert, Stefano Cannata, Brian Whisenant, Sabine Bleiziffer, Anthony C. Chyou, Azeem Latib, Antonio H. Frangieh, Sung Han Yoon, Jean Bernard Masson, David Hildick-Smith, Christian Hengstenberg, Enrique Gutiérrez-Ibañes, Stephan Windecker, Tsuyoshi Kaneko, Lenard Conradi, Guiherme F. Attizzani, S. Chiu Wong, Ulrich Schaefer, Maurizio Taramasso, Colin MacLeod Barker, Tomaz Podlesnikar, Albert M. Kasel, Bernard Prendergast, Simon Redwood, Fabian Nietlispach, Rahul Sharma, Yoon, Sung-han, Whisenant, Brian K., Bleiziffer, Sabine, Delgado, Victoria, Schofer, Nikla, Eschenbach, Lena, Fujita, Buntaro, Sharma, Rahul, Ancona, Marco, Yzeiraj, Ermela, Cannata, Stefano, Barker, Colin, Davies, James E., Frangieh, Antonio H., Deuschl, Florian, Podlesnikar, Tomaz, Asami, Masahiko, Dhoble, Abhijeet, Chyou, Anthony, Masson, Jean-bernard, Wijeysundera, Harindra C., Blackman, Daniel J., Rampat, Rajiv, Taramasso, Maurizio, Gutierrez-ibanes, Enrique, Chakravarty, Tarun, Attizzani, Guiherme F., Kaneko, Tsuyoshi, Wong, S. Chiu, Sievert, Horst, Nietlispach, Fabian, Hildick-smith, David, Nombela-franco, Lui, Conradi, Lenard, Hengstenberg, Christian, Reardon, Michael J., Kasel, Albert Marku, Redwood, Simon, Colombo, Antonio, Kar, Saibal, Maisano, Francesco, Windecker, Stephan, Pilgrim, Thoma, Ensminger, Stephan M., Prendergast, Bernard D., Schofer, Joachim, Schaefer, Ulrich, Bax, Jeroen J., Latib, Azeem, and Makkar, Raj R
- Subjects
Male ,Reoperation ,mitral valve ,medicine.medical_specialty ,Cardiac Catheterization ,Mitral Valve Annuloplasty ,medicine.medical_treatment ,Heart Valve Diseases ,Annuloplasty rings ,030204 cardiovascular system & hematology ,Valve in ring ,Prosthesis Design ,degenerated bioprosthese ,03 medical and health sciences ,0302 clinical medicine ,Retrospective Studie ,transcatheter valve implantation ,Mitral valve ,Internal medicine ,medicine ,Humans ,In patient ,030212 general & internal medicine ,610 Medicine & health ,Bioprosthesi ,Retrospective Studies ,Aged ,Bioprosthesis ,Heart Valve Prosthesis Implantation ,Ejection fraction ,business.industry ,Mitral valve replacement ,annuloplasty ring ,Prosthesis Failure ,Europe ,Survival Rate ,Heart Valve Disease ,medicine.anatomical_structure ,Treatment Outcome ,degenerated bioprostheses ,North America ,Cardiology ,Female ,business ,Cardiology and Cardiovascular Medicine ,Human - Abstract
Background Limited data exist regarding transcatheter mitral valve replacement (TMVR) for patients with failed mitral valve replacement and repair. Objectives This study sought to evaluate the outcomes of TMVR in patients with failed mitral bioprosthetic valves (valve-in-valve [ViV]) and annuloplasty rings (valve-in-ring [ViR]). Methods From the TMVR multicenter registry, procedural and clinical outcomes of mitral ViV and ViR were compared according to Mitral Valve Academic Research Consortium criteria. Results A total of 248 patients with mean Society of Thoracic Surgeons score of 8.9 ± 6.8% underwent TMVR. Transseptal access and the balloon-expandable valve were used in 33.1% and 89.9%, respectively. Compared with 176 patients undergoing ViV, 72 patients undergoing ViR had lower left ventricular ejection fraction (45.6 ± 17.4% vs. 55.3 ± 11.1%; p < 0.001). Overall technical and device success rates were acceptable, at 92.3% and 85.5%, respectively. However, compared with the ViV group, the ViR group had lower technical success (83.3% vs. 96.0%; p = 0.001) due to more frequent second valve implantation (11.1% vs. 2.8%; p = 0.008), and lower device success (76.4% vs. 89.2%; p = 0.009) due to more frequent reintervention (16.7% vs. 7.4%; p = 0.03). Mean mitral valve gradients were similar between groups (6.4 ± 2.3 mm Hg vs. 5.8 ± 2.7 mm Hg; p = 0.17), whereas the ViR group had more frequent post-procedural mitral regurgitation moderate or higher (19.4% vs. 6.8%; p = 0.003). Furthermore, the ViR group had more frequent life-threatening bleeding (8.3% vs. 2.3%; p = 0.03), acute kidney injury (11.1% vs. 4.0%; p = 0.03), and subsequent lower procedural success (58.3% vs. 79.5%; p = 0.001). The 1-year all-cause mortality rate was significantly higher in the ViR group compared with the ViV group (28.7% vs. 12.6%; log-rank test, p = 0.01). On multivariable analysis, failed annuloplasty ring was independently associated with all-cause mortality (hazard ratio: 2.70; 95% confidence interval: 1.34 to 5.43; p = 0.005). Conclusions The TMVR procedure provided acceptable outcomes in high-risk patients with degenerated bioprostheses or failed annuloplasty rings, but mitral ViR was associated with higher rates of procedural complications and mid-term mortality compared with mitral ViV.
- Published
- 2017