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Transcatheter aortic valve replacement in patients with severe mitral or tricuspid regurgitation at extreme risk for surgery
- Source :
- The Journal of Thoracic and Cardiovascular Surgery. 155:1991-1999
- Publication Year :
- 2018
- Publisher :
- Elsevier BV, 2018.
-
Abstract
- Objectives Patients with symptomatic severe aortic stenosis and severe mitral regurgitation or severe tricuspid regurgitation were excluded from the major transcatheter aortic valve replacement trials. We studied these 2 subgroups in patients at extreme risk for surgery in the prospective, nonrandomized, single-arm CoreValve US Expanded Use Study. Methods The primary end point was all-cause mortality or major stroke at 1 year. A favorable medical benefit was defined as a Kansas City Cardiomyopathy Questionnaire overall summary score greater than 45 at 6 months and greater than 60 at 1 year and with a less than 10-point decrease from baseline. Results There were 53 patients in each group. Baseline characteristics for the severe mitral regurgitation and severe tricuspid regurgitation cohorts were age 84.2 ± 6.4 years and 84.9 ± 6.5 years; male, 29 (54.7%) and 22 (41.5%), and mean Society of Thoracic Surgeons score 9.9% ± 5.0% and 9.2% ± 4.0%, respectively. Improvement in valve regurgitation from baseline to 1 year occurred in 72.7% of the patients with severe mitral regurgitation and in 61.8% of patients with severe tricuspid regurgitation. A favorable medical benefit occurred in 31 of 47 patients (66.0%) with severe mitral regurgitation and 33 of 47 patients (70.2%) with severe tricuspid regurgitation at 6 months, and in 25 of 44 patients (56.8%) with severe mitral regurgitation and 24 of 45 patients (53.3%) with severe tricuspid regurgitation at 1 year. All-cause mortality or major stroke for the severe mitral regurgitation and severe tricuspid regurgitation cohorts were 11.3% and 3.8% at 30 days and 21.0% and 19.2% at 1 year, respectively. There were no major strokes in either group at 1 year. Conclusions Transcatheter aortic valve replacement in patients with severe mitral regurgitation or severe tricuspid regurgitation is reasonable and safe and leads to improvement in atrioventricular valve regurgitation.
- Subjects :
- Pulmonary and Respiratory Medicine
Mitral regurgitation
Atrioventricular valve
medicine.medical_specialty
business.industry
medicine.medical_treatment
macromolecular substances
Regurgitation (circulation)
030204 cardiovascular system & hematology
medicine.disease
Surgery
03 medical and health sciences
Stenosis
0302 clinical medicine
Valve replacement
cardiovascular system
medicine
cardiovascular diseases
030212 general & internal medicine
Tricuspid Valve Regurgitation
Cardiology and Cardiovascular Medicine
Mitral valve regurgitation
business
Stroke
Subjects
Details
- ISSN :
- 00225223
- Volume :
- 155
- Database :
- OpenAIRE
- Journal :
- The Journal of Thoracic and Cardiovascular Surgery
- Accession number :
- edsair.doi...........386a5aa25c8b21d4320bce31df6a7c2f