TY - JOUR
T1 - Transcatheter Treatment of Residual Significant Mitral Regurgitation Following TAVR
T2 - A Multicenter Registry
AU - Witberg, Guy
AU - Codner, Pablo
AU - Landes, Uri
AU - Brabanti, Marco
AU - Valvo, Roberto
AU - De Backer, Ole
AU - Ooms, Joris F.
AU - Sievert, Kolja
AU - El Sabbagh, Abdallah
AU - Jimenez-Quevedo, Pilar
AU - Brennan, Paul F.
AU - Sedaghat, Alexander
AU - Masiero, Giulia
AU - Werner, Paul
AU - Overtchouk, Pavel
AU - Watanabe, Yusuke
AU - Montorfano, Matteo
AU - Bijjam, Venu Reddy
AU - Hein, Manuel
AU - Fiorina, Claudia
AU - Arzamendi, Dabit
AU - Rodriguez-Gabella, Tania
AU - Fernández-Vázquez, Felipe
AU - Baz, Jose A.
AU - Laperche, Clemence
AU - Grasso, Carmelo
AU - Branca, Luca
AU - Estévez-Loureiro, Rodrigo
AU - Benito-González, Tomás
AU - Amat Santos, Ignacio J.
AU - Ruile, Philipp
AU - Mylotte, Darren
AU - Buzzatti, Nicola
AU - Piazza, Nicolo
AU - Andreas, Martin
AU - Tarantini, Giuseppe
AU - Sinning, Jan Malte
AU - Spence, Mark S.
AU - Nombela-Franco, Luis
AU - Guerrero, Mayra
AU - Sievert, Horst
AU - Sondergaard, Lars
AU - Van Mieghem, Nicolas M.
AU - Tchetche, Didier
AU - Webb, John G.
AU - Kornowski, Ran
PY - 2020
Y1 - 2020
N2 - Objectives: The aim of this study was to describe baseline characteristics, and periprocedural and mid-term outcomes of patients undergoing transcatheter mitral valve interventions post-transcatheter aortic valve replacement (TAVR) and examine their clinical benefit. Background: The optimal management of residual mitral regurgitation (MR) post-TAVR is challenging. Methods: This was an international registry of 23 TAVR centers. Results: In total, 106 of 24,178 patients (0.43%) underwent mitral interventions post-TAVR (100 staged, 6 concomitant), most commonly percutaneous edge-to-edge mitral valve repair (PMVR). The median interval post-TAVR was 164 days. Mean age was 79.5 ± 7.2 years, MR was >moderate in 97.2%, technical success was 99.1%, and 30-day device success rate was 88.7%. There were 18 periprocedural complications (16.9%) including 4 deaths. During a median follow-up of 464 days, the cumulative risk for 3-year mortality was 29.0%. MR grade and New York Heart Association (NYHA) functional class improved dramatically; at 1 year, MR was moderate or less in 90.9% of patients (mild or less in 69.1%), and 85.9% of patients were in NYHA functional class I/II. Staged PMVR was associated with lower mortality versus medical treatment (57.5% vs. 30.8%) in a propensity-matched cohort (n = 156), but this was not statistically significant (hazard ratio: 1.75; p = 0.05). Conclusions: For patients who continue to have significant MR, remain symptomatic post-TAVR, and are anatomically suitable for transcatheter interventions, these interventions are feasible, safe, and associated with significant improvement in MR grade and NYHA functional class. These results apply mainly to PMVR. A staged PMVR strategy was associated with markedly lower mortality, but this was not statistically significant. (Transcatheter Treatment for Combined Aortic and Mitral Valve Disease. The Aortic+Mitral TRAnsCatheter Valve Registry [AMTRAC]; NCT04031274)
AB - Objectives: The aim of this study was to describe baseline characteristics, and periprocedural and mid-term outcomes of patients undergoing transcatheter mitral valve interventions post-transcatheter aortic valve replacement (TAVR) and examine their clinical benefit. Background: The optimal management of residual mitral regurgitation (MR) post-TAVR is challenging. Methods: This was an international registry of 23 TAVR centers. Results: In total, 106 of 24,178 patients (0.43%) underwent mitral interventions post-TAVR (100 staged, 6 concomitant), most commonly percutaneous edge-to-edge mitral valve repair (PMVR). The median interval post-TAVR was 164 days. Mean age was 79.5 ± 7.2 years, MR was >moderate in 97.2%, technical success was 99.1%, and 30-day device success rate was 88.7%. There were 18 periprocedural complications (16.9%) including 4 deaths. During a median follow-up of 464 days, the cumulative risk for 3-year mortality was 29.0%. MR grade and New York Heart Association (NYHA) functional class improved dramatically; at 1 year, MR was moderate or less in 90.9% of patients (mild or less in 69.1%), and 85.9% of patients were in NYHA functional class I/II. Staged PMVR was associated with lower mortality versus medical treatment (57.5% vs. 30.8%) in a propensity-matched cohort (n = 156), but this was not statistically significant (hazard ratio: 1.75; p = 0.05). Conclusions: For patients who continue to have significant MR, remain symptomatic post-TAVR, and are anatomically suitable for transcatheter interventions, these interventions are feasible, safe, and associated with significant improvement in MR grade and NYHA functional class. These results apply mainly to PMVR. A staged PMVR strategy was associated with markedly lower mortality, but this was not statistically significant. (Transcatheter Treatment for Combined Aortic and Mitral Valve Disease. The Aortic+Mitral TRAnsCatheter Valve Registry [AMTRAC]; NCT04031274)
KW - aortic stenosis
KW - mitral regurgitation
KW - TAVR
KW - TMVR/r
U2 - 10.1016/j.jcin.2020.07.014
DO - 10.1016/j.jcin.2020.07.014
M3 - Journal article
C2 - 33303117
AN - SCOPUS:85097433454
VL - 13
SP - 2782
EP - 2791
JO - J A C C: Cardiovascular Interventions
JF - J A C C: Cardiovascular Interventions
SN - 1936-8798
IS - 23
ER -