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Darouei B, Amani-Beni R, Rabiee Rad M, Ghasempour Dabaghi G, Eshraghi R, Bahrami A, Amini-Salehi E, Hashemi SM, Mazaheri-Tehrani S, Movahed MR. The Impact of Concomitant Mitral Regurgitation on Echocardiography Parameters After TransCatheter Aortic Valve Replacement: A Systematic Review and Meta-Analysis. Catheter Cardiovasc Interv 2025. [PMID: 40270122 DOI: 10.1002/ccd.31555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2025] [Accepted: 04/16/2025] [Indexed: 04/25/2025]
Abstract
BACKGROUND Mitral regurgitation (MR) commonly coexists with aortic stenosis (AS) and is a potential risk factor influencing outcomes following transcatheter aortic valve replacement (TAVR). This meta-analysis aimed to evaluate the mean changes in key echocardiographic parameters before and after TAVR and to compare these changes between patients with moderate-to-severe MR (MR ≥ 2) and those with none-to-mild MR (MR < 2). METHODS A comprehensive literature search was conducted using six electronic databases. We included studies that evaluated patients undergoing TAVR, classified them based on baseline MR grade ≥ 2 (moderate/severe MR) or MR grade < 2 (none/mild MR), and reported the mean difference (MD) in echocardiographic parameters before and after TAVR in both groups. The primary outcomes included changes in ejection fraction (EF), LV end-diastolic volume (LVEDV) index, LV end-systolic volume (LVESV) index, LV end-diastolic diameter (LVEDD), LV end-systolic diameter (LVESD), aortic valve area (AVA), and the mean aortic gradient. Pooled MDs were analyzed using a random-effects model. RESULTS Thirteen studies with 7163 patients were included, of which 2376 had an MR ≥ 2. The MR < 2 and MR ≥ 2 groups experienced significant improvements in AVA and reductions in mean aortic gradient, LVEDV index, LVESV index, LVEDD, and LVESD. Compared to MR < 2 patients, those with MR ≥ 2 exhibited significantly greater improvements in EF (MD = 2.03; 95% CI: 0.81, 3.24), LVEDV index (MD = -5.55; 95% CI: -7.85, -3.26), LVESV index (MD = -5.43; 95% CI: -7.28, -3.58), LVESD (MD = -2.23; 95% CI: -3.71, -0.26), and mean aortic gradient (MD = 1.43; 95% CI: 0.79, 2.07). However, the changes in LVEDD and AVA were not significantly different between the groups. CONCLUSIONS These findings suggest that patients with moderate-to-severe baseline MR before TAVR showed greater pronounced improvements in specific echocardiographic parameters related to LV function and geometry, particularly in LVEF, LVEDV index, LVESV index, and LVESD, compared to those with none-to-mild MR. Future studies should focus on stratifying outcomes according to MR etiology and using advanced imaging techniques to delineate better the mechanisms underlying these improvements.
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Affiliation(s)
- Bahar Darouei
- Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Reza Amani-Beni
- Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mehrdad Rabiee Rad
- Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Ghazal Ghasempour Dabaghi
- Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Reza Eshraghi
- Social Determinants of Health Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Ashkan Bahrami
- Student Research Committee, Kashan University of Medical Sciences, Kashan, Iran
| | | | - Seyyed Mohammad Hashemi
- Cardiovascular Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Sadegh Mazaheri-Tehrani
- Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non-Communicable Disease, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mohammad Reza Movahed
- Department of Medicine, University of Arizona College of Medicine, Phoenix, USA
- Department of Medicine, University of Arizona Sarver Heart Center, Tucson, Arizona, USA
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Amani-Beni R, Darouei B, Rabiee Rad M, Ghasempour Dabaghi G, Eshraghi R, Bahrami A, Amini-Salehi E, Hashemi SM, Mazaheri-Tehrani S, Movahed MR. Perioperative Outcomes in Patients Undergoing Transcatheter Aortic Valve Replacement with Concomitant Mitral Regurgitation: A Meta-Analysis. Cardiol Rev 2025:00045415-990000000-00476. [PMID: 40262017 DOI: 10.1097/crd.0000000000000919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/24/2025]
Abstract
Transcatheter aortic valve replacement (TAVR) is widely performed in high-risk patients with severe aortic stenosis. However, the effects of baseline concomitant mitral regurgitation (MR) on perioperative outcomes remain unclear. This study evaluated the impact of concomitant MR severity on short-term TAVR outcomes. A systematic search of 6 electronic databases was conducted. Studies that stratified patients based on MR severity (MR ≥2 vs. <2 or MR ≥3 vs. <3) and reported perioperative outcomes, including short-term mortality, in-hospital mortality, acute kidney injury (AKI), pacemaker implantation, bleeding, vascular complications, and MR improvement (up to 1 week and 1 month) were eligible. Data from 26 studies (32,453 patients) demonstrated that patients with baseline moderate-to-severe MR (MR ≥2) had a 49% (95% confidence interval (CI), 1.32-1.70) increased risk of short-term mortality, a 41% (95% CI, 1.22-1.63) higher risk of in-hospital mortality, and a 38% (95% CI, 1.17-1.62) higher risk of AKI than those with none-to-mild MR (MR<2). Patients with an MR ≥3 had an even greater 72% (95% CI, 1.37-2.16) increase in short-term mortality. No significant differences were observed in pacemaker implantation, bleeding, or vascular complications between groups. Additionally, after TAVR, MR improved in 36% of patients by at least 1 grade within 1 week, increasing to 44% by 1 month. In TAVR patients, MR ≥2 was associated with significantly higher early mortality and AKI risk, underscoring the need for a comprehensive perioperative risk assessment. Future studies should examine the differential impact of functional and degenerative MR.
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Affiliation(s)
- Reza Amani-Beni
- From the Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Bahar Darouei
- From the Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mehrdad Rabiee Rad
- From the Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Ghazal Ghasempour Dabaghi
- From the Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Reza Eshraghi
- Social Determinants of Health Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Ashkan Bahrami
- Student Research Committee, Kashan University of Medical Sciences, Kashan, Iran
| | | | - Seyyed Mohammad Hashemi
- Cardiovascular Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Sadegh Mazaheri-Tehrani
- Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non-Communicable Disease, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mohammad Reza Movahed
- Department of Medicine, University of Arizona College of Medicine, Phoenix; and
- Department of Medicine, University of Arizona Sarver Heart Center, Tucson, AZ
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Doldi PM, Löw K, Steffen J, Fischer J, Tischmacher M, Knufinke N, Stocker TJ, Theiss H, Rizas K, Stark K, Hagl C, Näbauer M, Massberg S, Hausleiter J, Deseive S. Impact of Dual Atrioventricular Valve Disease on Outcomes in patients undergoing Transcatheter Aortic Valve Replacement. Eur Heart J Cardiovasc Imaging 2025:jeaf112. [PMID: 40215283 DOI: 10.1093/ehjci/jeaf112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2024] [Revised: 01/28/2025] [Accepted: 03/13/2025] [Indexed: 04/25/2025] Open
Abstract
BACKGROUND Current guidelines provide no recommendations for the management of patients with dual atrioventricular valve regurgitation (DAVR) undergoing transcatheter aortic valve replacement (TAVR), and existing data on its clinical impact remain absent.Therefore, we aimed to provide detailed insights into the impact of DAVR on outcomes after TAVR, with the potential to refine clinical risk-stratification tools and influence future management guidelines. METHODS AND RESULTS We retrospectively analyzed 3,491 consecutive patients who underwent TAVR between 2013 and 2021. DAVR was defined as the presence of both MR and TR ≥2+. Patients were divided into four groups based on echocardiography before TAVR: no/mild atrioventricular (AV) regurgitation, isolated MR≥2+, isolated TR≥2+, and DAVR.DAVR was present in 269 patients (7.7%) and was associated with significantly reduced 3-year survival (47.3%) compared to isolated MR (64.3%), isolated TR (54.4%), and no/mild AV regurgitation (73.0%, p<0.001). Multivariate analysis identified DAVR as an independent predictor of 3-year mortality (HR 1.36, 95% CI 1.1-1.8, p=0.021). A leading TR≥3+ in DAVR patients was associated with a particularly poor prognosis (3-year survival: 27%). While an MR improvement following TAVR was linked to better survival (HR 0.45, 95% CI 0.30-0.69, p<0.001), a TR improvement had no significant impact on survival (HR: 0.69, 95%CI: 0.45-1.05, p=0.086). Notably, 54% of DAVR patients continued to experience significant exertional dyspnea at follow-up (NYHA≥II). CONCLUSIONS These findings underscore the importance of recognizing DAVR as a high-risk condition in TAVR patients, highlighting the need for refined risk-stratification tools and potential adjunctive therapeutic strategies to improve outcomes.
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Affiliation(s)
- Philipp M Doldi
- Medizinische Klinik und Poliklinik I, LMU Klinikum, LMU München, Germany
- Munich Heart Alliance, German Center for Cardiovascular Research (DZHK), Munich, Germany
| | - Kornelia Löw
- Medizinische Klinik und Poliklinik I, LMU Klinikum, LMU München, Germany
- Munich Heart Alliance, German Center for Cardiovascular Research (DZHK), Munich, Germany
| | - Julius Steffen
- Medizinische Klinik und Poliklinik I, LMU Klinikum, LMU München, Germany
- Munich Heart Alliance, German Center for Cardiovascular Research (DZHK), Munich, Germany
| | - Julius Fischer
- Medizinische Klinik und Poliklinik I, LMU Klinikum, LMU München, Germany
| | | | - Nike Knufinke
- Medizinische Klinik und Poliklinik I, LMU Klinikum, LMU München, Germany
| | - Thomas J Stocker
- Medizinische Klinik und Poliklinik I, LMU Klinikum, LMU München, Germany
- Munich Heart Alliance, German Center for Cardiovascular Research (DZHK), Munich, Germany
| | - Hans Theiss
- Medizinische Klinik und Poliklinik I, LMU Klinikum, LMU München, Germany
| | - Konstantinos Rizas
- Medizinische Klinik und Poliklinik I, LMU Klinikum, LMU München, Germany
- Munich Heart Alliance, German Center for Cardiovascular Research (DZHK), Munich, Germany
| | - Konstantin Stark
- Medizinische Klinik und Poliklinik I, LMU Klinikum, LMU München, Germany
- Munich Heart Alliance, German Center for Cardiovascular Research (DZHK), Munich, Germany
| | - Christian Hagl
- Herzchirurgische Klinik und Poliklinik, Klinikum der Universität München, Munich, Germany
| | - Michael Näbauer
- Medizinische Klinik und Poliklinik I, LMU Klinikum, LMU München, Germany
| | - Steffen Massberg
- Medizinische Klinik und Poliklinik I, LMU Klinikum, LMU München, Germany
- Munich Heart Alliance, German Center for Cardiovascular Research (DZHK), Munich, Germany
| | - Jörg Hausleiter
- Medizinische Klinik und Poliklinik I, LMU Klinikum, LMU München, Germany
- Munich Heart Alliance, German Center for Cardiovascular Research (DZHK), Munich, Germany
| | - Simon Deseive
- Medizinische Klinik und Poliklinik I, LMU Klinikum, LMU München, Germany
- Munich Heart Alliance, German Center for Cardiovascular Research (DZHK), Munich, Germany
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Baudo M, Sicouri S, Cabrucci F, Yamashita Y, Magouliotis DE, Carnila SM, Abramson SV, Hawthorne KM, Jarrett H, Rodriguez R, Goldman SM, Coady PM, Gnall EM, Gray WA, Gelsomino S, Ramlawi B. Evolution of Untreated Moderate Mitral Regurgitation After Transcatheter Aortic Valve Implantation. MEDICINA (KAUNAS, LITHUANIA) 2025; 61:686. [PMID: 40282977 PMCID: PMC12028619 DOI: 10.3390/medicina61040686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/06/2025] [Revised: 03/28/2025] [Accepted: 04/07/2025] [Indexed: 04/29/2025]
Abstract
Background and Objectives: Associated mitral regurgitation (MR) is frequently observed during transcatheter aortic valve implantation (TAVI). The progression of moderate MR remains undetermined, given uncertain clinical significance and natural history. This study aims to assess the evolution of moderate MR following TAVI. Materials and Methods: Between 2018 and 2023, 1476 patients underwent TAVI. We excluded those with previous aortic or mitral valve interventions, endocarditis, concomitant percutaneous coronary intervention, or emergent procedures. Patients with severe aortic or tricuspid regurgitation or significant mitral stenosis were excluded. Ultimately, only patients with moderate MR were included, resulting in a final population of 154 patients. Results: Mean age was 81.4 ± 7.8 years, 48.1% (74/154) were female, and 48.1% (74/154) were functional MR. There was one surgical conversion due to annular rupture. Thirty-day mortality was 1.9% (3/154). Postoperative echocardiography showed 38 (24.7%) patients with none/trace MR, 91 (59.1%) with mild MR, 22 (14.3%) with moderate MR, and 3 (1.9%) with severe MR. Finally, according to the echocardiographic follow-up [median follow-up 1.0 (IQR: 0.1-1.2) years], 20.1% (31/154) had no/trace MR, 39.6% (61/154) had mild MR, 35.7% (55/154) had moderate MR, and 4.5% (7/154) had severe MR. Overall, 67 (43.5%) patients had any MR grade progression, 62 (40.3%) had stable disease, and 25 (16.2%) had any MR grade reduction at the last follow-up from the operation. No difference in MR evolution was seen between functional and primary MR. Conclusions: Concomitant moderate MR during TAVI has a variable evolution over time. A more detailed characterization of patients with preoperative moderate MR undergoing TAVI is necessary to identify those with a disease progression risk.
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Affiliation(s)
- Massimo Baudo
- Department of Cardiac Surgery Research, Lankenau Institute for Medical Research, Main Line Health, Wynnewood, PA 19096, USA; (S.S.); (F.C.); (Y.Y.); (D.E.M.); (S.M.C.); (W.A.G.); (B.R.)
| | - Serge Sicouri
- Department of Cardiac Surgery Research, Lankenau Institute for Medical Research, Main Line Health, Wynnewood, PA 19096, USA; (S.S.); (F.C.); (Y.Y.); (D.E.M.); (S.M.C.); (W.A.G.); (B.R.)
| | - Francesco Cabrucci
- Department of Cardiac Surgery Research, Lankenau Institute for Medical Research, Main Line Health, Wynnewood, PA 19096, USA; (S.S.); (F.C.); (Y.Y.); (D.E.M.); (S.M.C.); (W.A.G.); (B.R.)
| | - Yoshiyuki Yamashita
- Department of Cardiac Surgery Research, Lankenau Institute for Medical Research, Main Line Health, Wynnewood, PA 19096, USA; (S.S.); (F.C.); (Y.Y.); (D.E.M.); (S.M.C.); (W.A.G.); (B.R.)
- Department of Cardiac Surgery, Lankenau Heart Institute, Main Line Health, Wynnewood, PA 19096, USA; (R.R.); (S.M.G.)
| | - Dimitrios E. Magouliotis
- Department of Cardiac Surgery Research, Lankenau Institute for Medical Research, Main Line Health, Wynnewood, PA 19096, USA; (S.S.); (F.C.); (Y.Y.); (D.E.M.); (S.M.C.); (W.A.G.); (B.R.)
| | - Sarah M. Carnila
- Department of Cardiac Surgery Research, Lankenau Institute for Medical Research, Main Line Health, Wynnewood, PA 19096, USA; (S.S.); (F.C.); (Y.Y.); (D.E.M.); (S.M.C.); (W.A.G.); (B.R.)
| | - Sandra V. Abramson
- Department of Interventional Cardiology, Cardiovascular Imaging Center, Lankenau Heart Institute, Main Line Health, Wynnewood, PA 19096, USA; (S.V.A.); (K.M.H.); (H.J.)
| | - Katie M. Hawthorne
- Department of Interventional Cardiology, Cardiovascular Imaging Center, Lankenau Heart Institute, Main Line Health, Wynnewood, PA 19096, USA; (S.V.A.); (K.M.H.); (H.J.)
| | - Harish Jarrett
- Department of Interventional Cardiology, Cardiovascular Imaging Center, Lankenau Heart Institute, Main Line Health, Wynnewood, PA 19096, USA; (S.V.A.); (K.M.H.); (H.J.)
| | - Roberto Rodriguez
- Department of Cardiac Surgery, Lankenau Heart Institute, Main Line Health, Wynnewood, PA 19096, USA; (R.R.); (S.M.G.)
| | - Scott M. Goldman
- Department of Cardiac Surgery, Lankenau Heart Institute, Main Line Health, Wynnewood, PA 19096, USA; (R.R.); (S.M.G.)
| | - Paul M. Coady
- Department of Interventional Cardiology, Lankenau Heart Institute, Main Line Health, Wynnewood, PA 19096, USA; (P.M.C.); (E.M.G.)
| | - Eric M. Gnall
- Department of Interventional Cardiology, Lankenau Heart Institute, Main Line Health, Wynnewood, PA 19096, USA; (P.M.C.); (E.M.G.)
| | - William A. Gray
- Department of Cardiac Surgery Research, Lankenau Institute for Medical Research, Main Line Health, Wynnewood, PA 19096, USA; (S.S.); (F.C.); (Y.Y.); (D.E.M.); (S.M.C.); (W.A.G.); (B.R.)
- Department of Interventional Cardiology, Lankenau Heart Institute, Main Line Health, Wynnewood, PA 19096, USA; (P.M.C.); (E.M.G.)
| | - Sandro Gelsomino
- Cardiovascular Research Institute Maastricht—CARIM, Maastricht University Medical Centre, 6229 ER Maastricht, The Netherlands;
| | - Basel Ramlawi
- Department of Cardiac Surgery Research, Lankenau Institute for Medical Research, Main Line Health, Wynnewood, PA 19096, USA; (S.S.); (F.C.); (Y.Y.); (D.E.M.); (S.M.C.); (W.A.G.); (B.R.)
- Department of Cardiac Surgery, Lankenau Heart Institute, Main Line Health, Wynnewood, PA 19096, USA; (R.R.); (S.M.G.)
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Lo Iudice F, Ravera A, Campanile A, Romei S, Vigorito F. Cardiogenic shock in a patient with combined severe aortic and mitral regurgitation treated by a totally percutaneous approach: a case report. Eur Heart J Case Rep 2025; 9:ytaf185. [PMID: 40290166 PMCID: PMC12032388 DOI: 10.1093/ehjcr/ytaf185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2024] [Revised: 01/11/2025] [Accepted: 04/03/2025] [Indexed: 04/30/2025]
Abstract
Background Combined severe aortic regurgitation and severe mitral regurgitation is a condition associated with high mortality, where evidence, about proper management, is still scarce, especially in critical clinical conditions such as cardiogenic shock. Case summary An 86-year-old female with severe aortic and mitral regurgitation was admitted due to acute pulmonary oedema, rapidly deteriorating in cardiogenic shock refractory to medical treatment. Haemodynamic stabilization was achieved only after implantation of an Impella CP, through a trans-femoral approach. Considering the prohibitive surgical risk, the mitral valve regurgitation was treated with a transcatheter edge-to-edge repair procedure, which allowed to successfully wean the patient from Impella. Subsequently, a transcatheter aortic valve implantation was performed. The patient's clinical status improved to such a level that a rehabilitation program was successfully implemented. Discussion Our report shows that an entirely percutaneous approach, to manage a combined severe aortic and mitral regurgitation, complicated by cardiogenic shock, is feasible and effective.
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Affiliation(s)
- Francesco Lo Iudice
- Cardiology Department, S. Giovanni Di Dio E Ruggi D’Aragona Hospital of Salerno, Largo Città di Ippocrate, Salerno 84131, Italy
| | - Amelia Ravera
- Cardiology Department, S. Giovanni Di Dio E Ruggi D’Aragona Hospital of Salerno, Largo Città di Ippocrate, Salerno 84131, Italy
| | - Alfonso Campanile
- Cardiology Department, S. Giovanni Di Dio E Ruggi D’Aragona Hospital of Salerno, Largo Città di Ippocrate, Salerno 84131, Italy
| | - Stefano Romei
- Cardiology Department, S. Giovanni Di Dio E Ruggi D’Aragona Hospital of Salerno, Largo Città di Ippocrate, Salerno 84131, Italy
| | - Francesco Vigorito
- Cardiology Department, S. Giovanni Di Dio E Ruggi D’Aragona Hospital of Salerno, Largo Città di Ippocrate, Salerno 84131, Italy
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Davalan W, Ben Ali W, Mrad S, Noly PE. What Are SAVR Indications in the TAVI Era? J Clin Med 2025; 14:2357. [PMID: 40217806 PMCID: PMC11989778 DOI: 10.3390/jcm14072357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2025] [Revised: 03/17/2025] [Accepted: 03/21/2025] [Indexed: 04/14/2025] Open
Abstract
While surgical aortic valve replacement (SAVR) has traditionally been regarded as the gold standard for severe symptomatic aortic stenosis (AS), transcatheter aortic valve implantation (TAVI) has emerged as a compelling less invasive alternative for patients with severe AS across the entire surgical risk spectrum. Despite TAVI's increasing utilization and promising outcomes, SAVR continues to be an essential treatment modality for certain patient populations, including individuals with complex aortic anatomies unsuitable for TAVI, patients presenting with significant aortic regurgitation, individuals requiring concomitant surgical procedures, and cases involving infective endocarditis. Furthermore, concerns regarding the long-term durability and complication profile of transcatheter valves underscore the importance of individualized patient assessment, especially for younger patients requiring optimal lifetime management strategies. This review examines the evolving role of SAVR amidst the growing adoption of TAVI and highlights key considerations for selecting the most appropriate treatment strategy for patients with aortic valve disease, incorporating insights from recent advancements in transcatheter technologies and the latest clinical trial evidence.
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Affiliation(s)
- William Davalan
- Montreal Heart Institute Research Centre, Université de Montréal, 5000 Est Belanger Street, Montreal, QC H1T 1C8, Canada
- Faculty of Medicine, McGill University, Montreal, QC H3A 0G4, Canada
| | - Walid Ben Ali
- Montreal Heart Institute Research Centre, Université de Montréal, 5000 Est Belanger Street, Montreal, QC H1T 1C8, Canada
- Department of Cardiac Surgery, Montreal Heart Institute, Université de Montréal, Montreal, QC H1T 1C8, Canada
| | - Sebastián Mrad
- Department of Interventional Cardiology, Montreal Heart Institute, Université de Montréal, Montreal, QC H1T 1C8, Canada
| | - Pierre-Emmanuel Noly
- Montreal Heart Institute Research Centre, Université de Montréal, 5000 Est Belanger Street, Montreal, QC H1T 1C8, Canada
- Department of Cardiac Surgery, Montreal Heart Institute, Université de Montréal, Montreal, QC H1T 1C8, Canada
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Güney MC, Süygün H, Polat M, Ayhan H, Keleş T, Turinay Ertop ZŞ, Bozkurt E. Prognostic Implications and Predictors of Mitral Regurgitancy Reduction After Transcatheter Aortic Valve Implantation. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:2077. [PMID: 39768956 PMCID: PMC11676227 DOI: 10.3390/medicina60122077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/18/2024] [Revised: 12/05/2024] [Accepted: 12/12/2024] [Indexed: 01/11/2025]
Abstract
Background: Mitral regurgitation (MR) is a common condition observed in patients undergoing transcatheter aortic valve implantation (TAVI) for the treatment of aortic stenosis (AS). However, the impact of TAVI on MR outcomes and the factors predicting MR improvement remains uncertain. Understanding these predictors can enhance patient management and guide clinical decisions. Methods: This retrospective cohort study included 156 patients with moderate to severe MR undergoing TAVI. MR severity was assessed via echocardiography at baseline, as well as 6 months and 1 year after TAVI. Patients were divided into groups based on MR reduction: no improvement or worsening, one-degree improvement, and at least two-degree improvement. Clinical, echocardiographic, and procedural characteristics were evaluated as predictive factors for MR improvement after TAVI. Results: MR reduction occurred in 68% of patients at 6 months and 81% at 1 year. Factors predicting a reduction of two grades or more in MR severity included lower baseline LVEDD (OR = 1.345, 95% CI: 1.112-1.628, p = 0.002) lower baseline LA (OR = 1.121, 95% CI: 1.015-1.237, p = 0.024), lower baseline LVMI (OR = 1.109, 95% CI: 1.020-1.207, p = 0.024), and higher baseline EF levels (OR = 1.701, 95% CI: 1.007-2.871, p = 0.047). No significant association was found between MR reduction at 6 months and one-year mortality. (p = 0.65). Conclusions: Baseline echocardiographic parameters are valuable in predicting MR improvement post-TAVI, with LVMI emerging as a novel predictor. However, MR reduction did not independently predict survival, underscoring the need for further research to optimize patient selection and management strategies in TAVI candidates.
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Affiliation(s)
- Murat Can Güney
- Medicana International Ankara Hospital, Department of Cardiology, Faculty of Medicine, Atılım University, Söğütözü, 2176. Sk. No: 3, Çankaya 06510, Turkey;
| | - Hakan Süygün
- Department of Cardiology, Faculty of Medicine, Karamanoglu Mehmetbey University, Karaman Training and Research Hospital, Karaman 70110, Turkey;
| | - Melike Polat
- Medicana International Ankara Hospital, Department of Cardiology, Faculty of Medicine, Atılım University, Söğütözü, 2176. Sk. No: 3, Çankaya 06510, Turkey;
| | - Hüseyin Ayhan
- Department of Cardiology, Faculty of Medicine, University of Health Sciences Gulhane, Ankara Bilkent City Hospital, Ankara 06800, Turkey;
| | - Telat Keleş
- Department of Cardiology, Faculty of Medicine, Ankara Yıldırım Beyazıt University, Ankara Bilkent City Hospital, Ankara 06800, Turkey;
| | - Zeynep Şeyma Turinay Ertop
- Department of Cardiology, Medicana International Ankara Hospital, Ankara 06530, Turkey; (Z.Ş.T.E.); (E.B.)
| | - Engin Bozkurt
- Department of Cardiology, Medicana International Ankara Hospital, Ankara 06530, Turkey; (Z.Ş.T.E.); (E.B.)
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Masson R, Nkomo VT, Holmes DR, Pislaru SV, Arsanjani R, Chao CJ, Klanderman M, Abraham B, Morsy M, Fortuin FD, Sweeney JP, Sell-Dotten K, Alsidawi S. Disproportionately high aortic valve calcium scores in atrial fibrillation: implications for transcatheter aortic valve replacement. Eur Heart J Cardiovasc Imaging 2024; 25:1264-1275. [PMID: 38669204 DOI: 10.1093/ehjci/jeae113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Revised: 03/23/2024] [Accepted: 04/09/2024] [Indexed: 04/28/2024] Open
Abstract
AIMS Doppler mean gradient (MG) can underestimate aortic stenosis (AS) severity in patients with atrial fibrillation (AF) compared with patients with sinus rhythm (SR), potentially delaying intervention in AF. This study compared outcomes in patients with AF and SR following transcatheter aortic valve replacement (TAVR) and investigated delay in TAVR based on computed tomography aortic valve calcium score (AVCS). METHODS AND RESULTS Patients who underwent TAVR from 2013 to 2017 for native valve severe AS were identified from an institutional database. Baseline characteristics and overall survival were compared between those with SR and AF. There were 820 patients (mean age 81 years; 41.6% females) included in this study. AF was present in 356 patients. Patients with AF were older (82.2 vs. 80.5, P = 0.003) and had a lower MG compared with patients with SR (42.0 vs. 44.9, P = 0.002) with similar indexed aortic valve area (0.4 vs. 0.4, P = 0.17). Median AVCS was higher in AF (males: AF 2850.0 vs. SR 2561.0, P = 0.044; females: AF 1942.0 vs. SR 1610.5, P = 0.025). Projected AVCS, assuming the same age of diagnosis, was similar between AF and SR. Median survival post-TAVR was worse in AF compared with SR (3.2 vs. 5.4 years, log rank P < 0.001). AF, lower MG, higher right ventricular systolic pressure, dialysis, diabetes, and significant tricuspid regurgitation were associated with higher mortality (P < 0.05 for all). CONCLUSION Older age and higher AVCS in patients with AF compared with those with SR suggest that AS was both underestimated and more advanced at TAVR referral.
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Affiliation(s)
- Rajeev Masson
- Department of Cardiovascular Diseases, Mayo Clinic Arizona, 13400 E Shea Blvd, Scottsdale, AZ 85259, USA
| | - Vuyisile T Nkomo
- Department of Cardiovascular Diseases, Mayo Clinic, 200 1st St SW, Rochester, MN 55905, USA
| | - David R Holmes
- Department of Cardiovascular Diseases, Mayo Clinic, 200 1st St SW, Rochester, MN 55905, USA
| | - Sorin V Pislaru
- Department of Cardiovascular Diseases, Mayo Clinic, 200 1st St SW, Rochester, MN 55905, USA
| | - Reza Arsanjani
- Department of Cardiovascular Diseases, Mayo Clinic Arizona, 13400 E Shea Blvd, Scottsdale, AZ 85259, USA
| | - Chieh-Ju Chao
- Department of Cardiovascular Diseases, Mayo Clinic, 200 1st St SW, Rochester, MN 55905, USA
| | - Molly Klanderman
- Department of Cardiovascular Diseases, Mayo Clinic Arizona, 13400 E Shea Blvd, Scottsdale, AZ 85259, USA
| | - Bishoy Abraham
- Department of Cardiovascular Diseases, Mayo Clinic Arizona, 13400 E Shea Blvd, Scottsdale, AZ 85259, USA
| | - Mahmoud Morsy
- Department of Cardiovascular Diseases, Mayo Clinic Arizona, 13400 E Shea Blvd, Scottsdale, AZ 85259, USA
| | - F David Fortuin
- Department of Cardiovascular Diseases, Mayo Clinic Arizona, 13400 E Shea Blvd, Scottsdale, AZ 85259, USA
| | - John P Sweeney
- Department of Cardiovascular Diseases, Mayo Clinic Arizona, 13400 E Shea Blvd, Scottsdale, AZ 85259, USA
| | - Kristen Sell-Dotten
- Department of Cardiovascular Diseases, Mayo Clinic Arizona, 13400 E Shea Blvd, Scottsdale, AZ 85259, USA
| | - Said Alsidawi
- Department of Cardiovascular Diseases, Mayo Clinic Arizona, 13400 E Shea Blvd, Scottsdale, AZ 85259, USA
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Nagasaka T, Shechter A, Patel V, Koren O, Chakravarty T, Cheng W, Ishii H, Jilaihawi H, Nakamura M, Makkar RR. Two-Year Clinical Outcomes of Staged Transcatheter Mitral Edge-to-Edge Repair After Transcatheter Aortic Valve Replacement. Am J Cardiol 2024; 224:46-54. [PMID: 38844194 DOI: 10.1016/j.amjcard.2024.05.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2024] [Revised: 05/17/2024] [Accepted: 05/24/2024] [Indexed: 06/19/2024]
Abstract
Residual significant mitral regurgitation (MR) can increase the risk of adverse events after transcatheter aortic valve replacement (TAVR). The clinical benefits of staged transcatheter edge-to-edge repair (TEER) after TAVR remain underexplored. This study aimed to investigate the clinical outcomes of staged TEER for residual significant MR after TAVR. This observational study included 314 consecutive patients with chronic residual grade 3+ or 4+ MR at the 30-day follow-up after TAVR, with 104 patients (33.1%) treated with staged TEER (TEER group) and 210 (66.9%) with medical therapy alone. The primary composite outcomes were all-cause mortality and heart failure hospitalization at 2 years. Additional analysis, including changes in MR grade and the New York Association functional classification, and subgroup outcome comparisons based on MR etiology were also conducted. In our study, the rate of primary composite outcome was lower in the TEER group than in the medical therapy alone group (33.7% vs 48.1%, p = 0.015). Significant improvement in MR grade and New York Association class was observed in the TEER group after 2 years. The subgroup analysis demonstrated that in patients with degenerative MR, a lower incidence of composite outcome and heart failure hospitalization was observed in the TEER group (hazard ratio 0.35, 95% confidence interval 0.23 to 0.53, p <0.001). In conclusion, staged TEER after TAVR was associated with reduced MR and improved clinical outcomes. The clinical significance of MR after TAVR should be carefully evaluated, and TEER should be considered for patients with significant residual MR, particularly, those with degenerative MR.
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Affiliation(s)
- Takashi Nagasaka
- Cedars-Sinai Medical Center, Smidt Heart Institute, Los Angeles, California; Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Alon Shechter
- Cedars-Sinai Medical Center, Smidt Heart Institute, Los Angeles, California; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Vivek Patel
- Cedars-Sinai Medical Center, Smidt Heart Institute, Los Angeles, California
| | - Ofir Koren
- Cedars-Sinai Medical Center, Smidt Heart Institute, Los Angeles, California; Bruce Rappaport Faculty of Medicine, Technion Israel Institute of Technology, Haifa, Israel
| | - Tarun Chakravarty
- Cedars-Sinai Medical Center, Smidt Heart Institute, Los Angeles, California
| | - Wen Cheng
- Cedars-Sinai Medical Center, Smidt Heart Institute, Los Angeles, California
| | - Hideki Ishii
- Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Hasan Jilaihawi
- Cedars-Sinai Medical Center, Smidt Heart Institute, Los Angeles, California
| | - Mamoo Nakamura
- Cedars-Sinai Medical Center, Smidt Heart Institute, Los Angeles, California.
| | - Raj R Makkar
- Cedars-Sinai Medical Center, Smidt Heart Institute, Los Angeles, California
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10
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Henrique Rangel R, Christoph Voran J, Seoudy H, Villinger T, Lutter G, Puehler T, Kreidel F, Frank J, Salem M, Frank D, Saad M. Transcatheter aortic valve replacement in patients with severe aortic valve stenosis and concomitant mitral valve regurgitation - 5 years follow-up. IJC HEART & VASCULATURE 2024; 53:101416. [PMID: 38854408 PMCID: PMC11157207 DOI: 10.1016/j.ijcha.2024.101416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Revised: 04/24/2024] [Accepted: 04/26/2024] [Indexed: 06/11/2024]
Abstract
Objectives To investigate the change in severity of mitral regurgitation (MR) after transcatheter aortic valve replacement (TAVR) and its effect on 5-year mortality. Background There is inconsistency in literature on pre-existing MR influencing long-term survival in patients who undergo TAVR. Methods Patients who underwent TAVR at the University Hospital Schleswig-Holstein (USKH) Campus Kiel between March 2009 and February 2018 have been enrolled. Echocardiography determined the degree of MR before and within 7 days after TAVR. Patients were divided into two groups according to their MR at baseline: MR-grade ≤ 2 (non-relevant MR, nr-MR) and baseline MR-grade > 2 (relevant MR, r-MR). Primary endpoint was a composite of MR baseline influence on mortality and MR reduction and its' impact on mortality. Results A total of 820 patients (642 nr-MR and 178 in r-MR) were included in this study. Of these, 167 patients showed an improvement in MR-grade. Thereof 106 (63.5 %) referred to r-MR with a significant decrease in mean MR-grade (p < 0.01). Systolic pulmonary artery pressure (sPAP) (p < 0.01) and NT-proBNP (p = 0.03) decreased in patients who had an improvement. There was no significant difference in 5-year mortality for MR at baseline (p = 0.35) or reduction in mortality for r-MR patients with an MR improvement compared to patients with worsening or equal MR status (p = 0.80). Conclusion In patients undergoing TAVR, 63.5 % of patients with MR-grade ≥ 2 at baseline showed an improvement of grade of MR after TAVR with reduction of their sPAP and NT-proBNP values but there was no significant difference in mortality.
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Affiliation(s)
- Rafael Henrique Rangel
- Department of Cardiology, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Jakob Christoph Voran
- Department of Cardiology, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
- DZHK (German Centre for Cardiovascular Research), partner site Hamburg, Kiel, Lübeck, Germany
| | - Hatim Seoudy
- Department of Cardiology, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
- DZHK (German Centre for Cardiovascular Research), partner site Hamburg, Kiel, Lübeck, Germany
| | - Theresa Villinger
- Department of Cardiology, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - G. Lutter
- DZHK (German Centre for Cardiovascular Research), partner site Hamburg, Kiel, Lübeck, Germany
- Department of Cardiac and Vascular Surgery, University Clinical Center Schleswig-Holstein (UKSH), Kiel, Germany
| | - T. Puehler
- DZHK (German Centre for Cardiovascular Research), partner site Hamburg, Kiel, Lübeck, Germany
- Department of Cardiac and Vascular Surgery, University Clinical Center Schleswig-Holstein (UKSH), Kiel, Germany
| | - Felix Kreidel
- Department of Cardiology, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Johanne Frank
- Department of Cardiology, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
- DZHK (German Centre for Cardiovascular Research), partner site Hamburg, Kiel, Lübeck, Germany
| | - Mostafa Salem
- Department of Cardiology, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Derk Frank
- Department of Cardiology, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
- DZHK (German Centre for Cardiovascular Research), partner site Hamburg, Kiel, Lübeck, Germany
| | - Mohammed Saad
- Department of Cardiology, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
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11
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Melillo F, Tavernese A, Rizza V, Putortì F, Preda A, Ancona F, Ingallina G, Stella S, Colombo A, Ancona M, Chieffo A, Buzzatti N, Castiglioni A, De Bonis M, Maisano F, Montorfano M, Agricola E. Impact on Outcome of Different Mechanisms, Baseline Degree and Changes of Mitral Regurgitation in Patients With Aortic Stenosis Who Underwent Transcatheter Aortic Valve Replacement. J Am Heart Assoc 2024; 13:e033125. [PMID: 38979804 PMCID: PMC11292747 DOI: 10.1161/jaha.123.033125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 05/24/2024] [Indexed: 07/10/2024]
Abstract
BACKGROUND Mitral regurgitation (MR) is frequent in patients with aortic stenosis (AS). Although primary MR is an established negative prognostic factor, whether different mechanisms of MR have different effects on outcome is currently unknown. The aim of this study was to evaluate the impact of the MR mechanism in patients undergoing transcatheter aortic valve replacement (TAVR). METHODS AND RESULTS This is a retrospective observational study of patients who underwent TAVR for severe aortic stenosis in a high-volume tertiary care center. Echocardiographic comprehensive MR assessment was performed at baseline and within 3 months post TAVR. The study population was divided into 4 groups according to MR mechanism: Group I: fibro-calcific leaflet degeneration; Group II: prolapse/flail; Group III: ventricular secondary MR (functional MR); and Group IV: atrial functional MR. The study end point was a combination of death from cardiovascular cause and heart failure-related hospitalization. The study population included 427 patients (mean age 81.7±6.5 years; 71% primary MR; 62% ≥moderate MR). At 3-year follow-up, survival free from the composite end point significantly differs according to MR mechanism: it was higher in group IV (atrial functional MR, 96.6%) compared with group I (80.4%, P=0.002) and group II patients (60.7%, P=0.001), and group III (84.8%, P=0.037); patients with MR due to leaflet prolapse showed poorer prognosis compared with patients with functional MR (group III, P=0.023 and group IV, P=0.001) and with group I (P=0.040). Overall, severe MR after TAVR identified patients with poorer prognosis and was significantly more frequent in group II (46.4%, P=0.001). CONCLUSIONS In patients undergoing TAVR, preprocedural identification of MR mechanism and mechanism provides prognostic insights.
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Affiliation(s)
- Francesco Melillo
- Cardiovascular Imaging Unit, Cardio‐Thoracic‐Vascular DepartmentIRCCS San Raffaele Scientific InstituteMilanItaly
- Echo Lab, Clinica Montevergine, GVM Care and ResearchMercoglianoItaly
- Cardiovascular Research Institute (CARIM)University of MaastrichtMaastrichtNetherlands
| | - Annamaria Tavernese
- Cardiovascular Imaging Unit, Cardio‐Thoracic‐Vascular DepartmentIRCCS San Raffaele Scientific InstituteMilanItaly
| | - Vincenzo Rizza
- Cardiovascular Imaging Unit, Cardio‐Thoracic‐Vascular DepartmentIRCCS San Raffaele Scientific InstituteMilanItaly
| | - Francesco Putortì
- Cardiovascular Imaging Unit, Cardio‐Thoracic‐Vascular DepartmentIRCCS San Raffaele Scientific InstituteMilanItaly
| | - Alberto Preda
- Cardiovascular Imaging Unit, Cardio‐Thoracic‐Vascular DepartmentIRCCS San Raffaele Scientific InstituteMilanItaly
| | - Francesco Ancona
- Cardiovascular Imaging Unit, Cardio‐Thoracic‐Vascular DepartmentIRCCS San Raffaele Scientific InstituteMilanItaly
| | - Giacomo Ingallina
- Cardiovascular Imaging Unit, Cardio‐Thoracic‐Vascular DepartmentIRCCS San Raffaele Scientific InstituteMilanItaly
| | - Stefano Stella
- Cardiovascular Imaging Unit, Cardio‐Thoracic‐Vascular DepartmentIRCCS San Raffaele Scientific InstituteMilanItaly
| | - Antonio Colombo
- Interventional Cardiology UnitHumanitas Research HospitalMilanItaly
| | - Marco Ancona
- Interventional Cardiology UnitIRCCS San Raffaele Scientific InstituteMilanItaly
| | - Alaide Chieffo
- Interventional Cardiology UnitIRCCS San Raffaele Scientific InstituteMilanItaly
- Heart Valve CentreIRCCS San Raffaele Scientific InstituteMilanItaly
- Vita‐Salute San Raffaele UniversityMilanItaly
| | - Nicola Buzzatti
- Heart Valve CentreIRCCS San Raffaele Scientific InstituteMilanItaly
| | - Alessandro Castiglioni
- Heart Valve CentreIRCCS San Raffaele Scientific InstituteMilanItaly
- Vita‐Salute San Raffaele UniversityMilanItaly
| | - Michele De Bonis
- Heart Valve CentreIRCCS San Raffaele Scientific InstituteMilanItaly
- Vita‐Salute San Raffaele UniversityMilanItaly
| | - Francesco Maisano
- Heart Valve CentreIRCCS San Raffaele Scientific InstituteMilanItaly
- Vita‐Salute San Raffaele UniversityMilanItaly
| | - Matteo Montorfano
- Interventional Cardiology UnitIRCCS San Raffaele Scientific InstituteMilanItaly
- Vita‐Salute San Raffaele UniversityMilanItaly
| | - Eustachio Agricola
- Cardiovascular Imaging Unit, Cardio‐Thoracic‐Vascular DepartmentIRCCS San Raffaele Scientific InstituteMilanItaly
- Vita‐Salute San Raffaele UniversityMilanItaly
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12
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Brunetti E, Lucà F, Presta R, Marchionni N, Boccanelli A, Ungar A, Rao CM, Ingianni N, Lettino M, Del Sindaco D, Murrone A, Riccio C, Colivicchi F, Grimaldi M, Gulizia MM, Oliva F, Bo M, Parrini I. A Comprehensive Geriatric Workup and Frailty Assessment in Older Patients with Severe Aortic Stenosis. J Clin Med 2024; 13:4169. [PMID: 39064209 PMCID: PMC11278149 DOI: 10.3390/jcm13144169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2024] [Revised: 07/04/2024] [Accepted: 07/09/2024] [Indexed: 07/28/2024] Open
Abstract
Aortic stenosis (AS) represents a notable paradigm for cardiovascular (CV) and geriatric disorders owing to comorbidity. Transcatheter aortic valve replacement (TAVR) was initially considered a therapeutic strategy in elderly individuals deemed unsuitable for or at high risk of surgical valve replacement. The progressive improvement in TAVR technology has led to the need to refine older patients' stratification, progressively incorporating the concept of frailty and other geriatric vulnerabilities. Recognizing the intricate nature of the aging process, reliance exclusively on chronological age for stratification resulted in an initial but inadequate tool to assess both CV and non-CV risks effectively. A comprehensive geriatric evaluation should be performed before TAVR procedures, taking into account both physical and cognitive capabilities and post-procedural outcomes through a multidisciplinary framework. This review adopts a multidisciplinary perspective to delve into the diagnosis and holistic management of AS in elderly populations in order to facilitate decision-making, thereby optimizing outcomes centered around patient well-being.
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Affiliation(s)
- Enrico Brunetti
- Geriatric Unit, Department of Medical Sciences, University of Turin, Hospital Città della Salute e della Scienza di Torino, 10126 Turin, Italy (R.P.); (M.B.)
- Department of Experimental and Clinical Medicine, University of Florence, Largo G. Brambilla 3, 50134 Florence, Italy
| | - Fabiana Lucà
- Cardiology Department, Grande Ospedale Metropolitano di Reggio, 89124 Reggio Calabria, Italy
| | - Roberto Presta
- Geriatric Unit, Department of Medical Sciences, University of Turin, Hospital Città della Salute e della Scienza di Torino, 10126 Turin, Italy (R.P.); (M.B.)
| | - Niccolò Marchionni
- Department of Experimental and Clinical Medicine, University of Florence, Largo G. Brambilla 3, 50134 Florence, Italy
| | | | - Andrea Ungar
- Department of Experimental and Clinical Medicine, University of Florence, Largo G. Brambilla 3, 50134 Florence, Italy
| | | | | | - Maddalena Lettino
- Department for Cardiac, Thoracic and Vascular Diseases, Fondazione IRCCS San Gerardo dei Tintori, 20900 Monza, Italy
| | | | - Adriano Murrone
- S.C. Cardiologia-UTIC, Ospedali di Città di Castello e di Gubbio-Gualdo Tadino, AUSL Umbria 1, 06127 Perugia, Italy
| | - Carmine Riccio
- Division of Clinical Cardiology, A.O.R.N. ‘Sant’Anna e San Sebastiano’, 81100 Caserta, Italy
| | - Furio Colivicchi
- Clinical and Rehabilitation Cardiology Unit, San Filippo Neri Hospital, 00135 Rome, Italy
| | - Massimo Grimaldi
- Cardiology Department, Miulli Hospital, Acquaviva delle Fonti, 70021 Bari, Italy
| | | | - Fabrizio Oliva
- Cardiovascular Department “A. De Gasperis”, ASST Niguarda Hospital, 20162 Milano, Italy
| | - Mario Bo
- Geriatric Unit, Department of Medical Sciences, University of Turin, Hospital Città della Salute e della Scienza di Torino, 10126 Turin, Italy (R.P.); (M.B.)
| | - Iris Parrini
- Department of Cardiology, Mauriziano Hospital, 10128 Turin, Italy
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13
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Polizzi G, Campos K, Coulter SA. Mitral regurgitation carries greater prognostic significance than mitral stenosis in patients undergoing transcatheter aortic valve replacement. J Cardiovasc Med (Hagerstown) 2024; 25:529-538. [PMID: 38829939 DOI: 10.2459/jcm.0000000000001629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2024]
Abstract
AIMS This study assessed the outcomes of concomitant mitral valve disease and severe aortic stenosis in patients undergoing transcatheter aortic valve replacement (TAVR). METHODS Echocardiographic data of 813 patients with severe aortic stenosis undergoing transfemoral TAVR were collected, and clinical outcomes were analyzed for individuals with mitral stenosis and mitral regurgitation. RESULTS The final cohort includes 788 patients with severe calcific aortic stenosis. Among single parameters of mitral stenosis, a smaller baseline mitral valve area (MVA) by the continuity equation and higher postprocedural mean mitral gradients (MMG) were associated with an increased risk of death at 1 year (P-values 0.02 and <0.01, respectively), but no correlation with outcomes was demonstrated after multivariate adjustment for major prognosticators. Mitral stenosis (based on MVA + MMG) was not associated with complications or mortality. Mitral regurgitation was present in 94.6% of the population at baseline and regressed by at least one grade post-TAVR in 28% of the patients. The improvement in mitral regurgitation was associated with a greater prosthetic effective orifice area (P-value 0.03). Significant (at least moderate) residual mitral regurgitation was correlated with short-term complications and shown to be an independent predictor of 1-year mortality (P-value 0.02, odds ratio (OR) 5.37, confidence interval 1.34-21.5). CONCLUSION Mitral regurgitation has a greater impact on TAVR patients than mitral stenosis as assessed by functional methods.
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Affiliation(s)
- Giovanni Polizzi
- Department of Cardiology, The Texas Heart Institute, Houston, TX, USA
| | - Karla Campos
- Center for Women's Heart and Vascular Health, The Texas Heart Institute, Houston, TX, USA
| | - Stephanie Alyse Coulter
- Department of Cardiology, The Texas Heart Institute, Houston, TX, USA
- Center for Women's Heart and Vascular Health, The Texas Heart Institute, Houston, TX, USA
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14
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Ramsay J, Tang Y, Kim JK, Frangieh AH. Transcatheter Treatment of Mitral Valve Regurgitation in the Setting of Concomitant Coronary or Multivalvular Heart Disease: A Focused Review. Interv Cardiol Clin 2024; 13:279-289. [PMID: 38432770 DOI: 10.1016/j.iccl.2023.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/05/2024]
Abstract
Treatment for mixed valve disease has historically been limited, often surgery being the only option. With the recent advancement of transcatheter therapies, percutaneous approaches are quickly becoming viable therapeutic considerations in inoperable or high-risk patients, also offering the option for a staged or same-session treatment. Guidelines are primarily focused on single-valve disease. However, patients often present with multiple pathologies. This review summarizes the data and literature on transcatheter treatment of patients with mitral regurgitation who concomitantly have aortic stenosis or regurgitation, tricuspid regurgitation, or ischemic cardiomyopathy. Pathophysiology, hemodynamics, available therapies as well as order and timing of interventions are discussed.
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Affiliation(s)
- Jay Ramsay
- Department of Internal Medicine, University of California Irvine, 333 City Boulevard West, City Tower Suite 400, Orange, CA 92868, USA
| | - Yicheng Tang
- Division of Cardiology, University of California Irvine, 333 City Boulevard West, City Tower Suite 400, Orange, CA 92868, USA
| | - Jin Kyung Kim
- Division of Cardiology, University of California Irvine, 333 City Boulevard West, City Tower Suite 400, Orange, CA 92868, USA
| | - Antonio H Frangieh
- Division of Cardiology, University of California Irvine, 333 City Boulevard West, City Tower Suite 400, Orange, CA 92868, USA.
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15
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Sugimori H, Nakao T, Okada Y, Okita Y, Yaku H, Kobayashi J, Uesugi H, Takanashi S, Ito T, Koyama T, Sakaguchi T, Yamamoto K, Yoshikawa Y, Sawa Y. Mid-term outcomes of surgical aortic valve replacement using a mosaic porcine bioprosthesis with concomitant mitral valve repair. Heart Vessels 2024; 39:252-265. [PMID: 37843552 DOI: 10.1007/s00380-023-02325-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 09/28/2023] [Indexed: 10/17/2023]
Abstract
This study retrospectively evaluated the mid-term outcomes of surgical aortic valve replacement (SAVR) using a stented porcine aortic valve bioprosthesis (Mosaic; Medtronic Inc., Minneapolis, MN, USA) with concomitant mitral valve (MV) repair. From 1999 to 2014, 157 patients (median [interquartile range] age, 75 [70-79] years; 47% women) underwent SAVR with concomitant MV repair (SAVR + MV repair), and 1045 patients (median [interquartile range] age, 76 [70-80] years; 54% women) underwent SAVR only at 10 centers in Japan as part of the long-term multicenter Japan Mosaic valve (J-MOVE) study. The 5-year overall survival rate was 81.5% ± 4.1% in the SAVR + MV repair group and 85.1% ± 1.4% in the SAVR only group, and the 8-year overall survival rates were 75.2% ± 5.7% and 78.1% ± 2.1%, respectively. Cox proportional hazards analysis showed no significant difference in the survival rates between the two groups (hazard ratio, 0.87; 95% confidence interval, 0.54-1.40; P = 0.576). Among women with mild or moderate mitral regurgitation who were not receiving dialysis, those who underwent SAVR + MV repair, were aged > 75 years, and had a preoperative left ventricular ejection fraction of 30-75% tended to have a lower mortality risk. In conclusion, this subgroup analysis of the J-MOVE cohort showed relevant mid-term outcomes after SAVR + MV repair.
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Affiliation(s)
- Haruhiko Sugimori
- Department of Cardiovascular Surgery, New Tokyo Hospital, 1271 Wanagaya, Matsudo, Chiba, 270-2232, Japan.
| | - Tatsuya Nakao
- Department of Cardiovascular Surgery, New Tokyo Hospital, 1271 Wanagaya, Matsudo, Chiba, 270-2232, Japan
| | - Yukikatsu Okada
- Department of Cardiovascular Surgery, Midori Hospital, 1-16 Edayoshi, Nishi-ku, Kobe, Hyogo, 651-2133, Japan
| | - Yutaka Okita
- Department of Cardiovascular Surgery, Takatsuki General Hospital, 1-3-13 Kosobe-Machi, Takatsuki, Osaka, 569-1192, Japan
| | - Hitoshi Yaku
- Department of Cardiovascular Surgery, Kyoto Prefectural University of Medicine, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Junjiro Kobayashi
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, 6-1 Kishibeshin-Machi, Suita, Osaka, 564-0018, Japan
| | - Hideyuki Uesugi
- Department of Cardiovascular Surgery, Saiseikai Kumamoto Hospital, 5-3-1 Chikami, Minami-ku, Kumamoto, Kumamoto, 861-4101, Japan
| | - Shuichiro Takanashi
- Department of Cardiovascular Surgery, Kawasaki Saiwai Hospital, 31-27 Omiya-Chyou, Saiwai-ku, Kawasaki, Kanagawa, 212-0014, Japan
| | - Toshiaki Ito
- Department of Cardiovascular Surgery, Japanese Red Cross Aichi Medical Center Nagoya Daiichi Hospital, 3-35 Michishita-Chyou, Nakamura-ku, Nagoya, Aichi, 453-0046, Japan
| | - Tadaaki Koyama
- Department of Cardiovascular Surgery, Kansai Medical University, 2-5-1 Shin-Machi, Hirakata, Osaka, 573-1010, Japan
| | - Taichi Sakaguchi
- Department of Cardiovascular Surgery, Hyogo College of Medicine, 1-3-6 Minatojima, Chuo-ku, Kobe, Hyogo, 650-0045, Japan
| | - Kouji Yamamoto
- Department of Biostatistics, Yokohama City University School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, Kanagawa, 236-0004, Japan
| | - Yasushi Yoshikawa
- Department of Cardiovascular Surgery, Tottori University, 4-101 Koyama-Cho, Minami, Tottori, 680-8550, Japan
| | - Yoshiki Sawa
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan
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16
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Alaour B, Nakase M, Pilgrim T. Combined Significant Aortic Stenosis and Mitral Regurgitation: Challenges in Timing and Type of Intervention. Can J Cardiol 2024; 40:235-249. [PMID: 37931671 DOI: 10.1016/j.cjca.2023.11.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 11/01/2023] [Accepted: 11/02/2023] [Indexed: 11/08/2023] Open
Abstract
In this narrative review, we aim to summarize the literature surrounding the assessment and management of the common, yet understudied combination of aortic stenosis (AS) and mitral regurgitation (MR), the components of which are complexly inter-related and interdependent from diagnostic, prognostic, and therapeutic perspectives. The hemodynamic interdependency of AS and MR confounds the assessment of the severity of each valve disease, thus underscoring the importance of a multimodal approach integrating valvular and extravalvular indicators of severity. A large body of literature suggests that baseline MR is associated with reduced survival post aortic valve (AV) intervention and that regression of MR post-AV intervention confers a mortality benefit. Functional MR is more likely to regress after AV intervention than primary MR. The respective natural courses of the 2 valve diseases are not synchronized; therefore, significant AS and MR at or above the respective threshold for intervention might not coincide. Surgery is primarily a 1-stop-shop procedure because of a considerable perioperative risk of repeat interventions, whereas transcatheter treatment modalities allow for a more tailored timing of intervention with reassessment of concomitant MR after AV replacement and a potential staged intervention in the absence of MR regression. In summary, AS and MR, when combined, are interlaced into a complex hemodynamic, diagnostic, and prognostic synergy, with important therapeutic implications. Contemporary approaches should consider stepwise intervention by exploiting the advantage of transcatheter options. However, evidence is needed to demonstrate the efficacy of different timing and therapeutic options.
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Affiliation(s)
- Bashir Alaour
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Masaaki Nakase
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Thomas Pilgrim
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
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17
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Arrotti S, Sgura FA, Leo G, Vitolo M, Monopoli D, Forzati N, Siena V, Menozzi M, Cataldo P, Stuani M, Morgante V, Magnavacchi P, Gabbieri D, Guiducci V, Benatti G, Vignali L, Rossi R, Boriani G. Atrial fibrillation before and after transcatheter aortic valve implantation: short- and long-term clinical implications. J Cardiovasc Med (Hagerstown) 2024; 25:51-59. [PMID: 38079281 PMCID: PMC10720825 DOI: 10.2459/jcm.0000000000001553] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 08/09/2023] [Indexed: 12/17/2023]
Abstract
BACKGROUND Patients with atrial fibrillation (AF) undergoing transcatheter aortic valve implantation (TAVI) have been associated with worse short-term outcomes compared with patients in sinus rhythm but data on long-term outcomes are limited. The aim of our study was to evaluate the association between AF and short- and long-term outcomes in patients undergoing TAVI. METHODS We retrospectively evaluated patients undergoing TAVI between 2012 and 2022 in four tertiary centres. Two different analyses were conducted: (i) in-hospital and (ii) postdischarge analysis. First, we evaluated the association between preexisting AF and short-term outcomes according to VARC-3 criteria. Second, we analyzed the association between AF at discharge (defined as both preexisting and new-onset AF occurring after TAVI) and long-term outcomes at median follow-up of 3.2 years (i.e. all-cause death, hospitalization and major adverse cardiovascular events). RESULTS A total of 759 patients were initially categorized according to the presence of preexisting AF (241 vs. 518 patients). The preexisting AF group had a higher occurrence of acute kidney injury [odds ratio (OR) 1.65; 95%confidence interval ( CI) 1.15-2.38] and major bleeding (OR 1.86, 95% CI 1.06-3.27). Subsequently, the population was categorized according to the presence of AF at discharge. At the adjusted Cox regression analysis, AF was independently associated with an increased risk of all-cause death and cardiovascular hospitalization [adjusted hazard ratio (aHR) 1.42, 95% CI 1.09-1.86], all-cause death and all-cause hospitalization (aHR 1.38, 95% CI 1.06-1.78) and all-cause hospitalization (aHR 1.59, 95% CI 1.14.2.22). CONCLUSIONS In a real-world cohort of patients undergoing TAVI, the presence of AF (preexisting and new-onset) was independently associated with both short- and long-term adverse outcomes.
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Affiliation(s)
- Salvatore Arrotti
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Moden
| | - Fabio Alfredo Sgura
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Moden
| | - Giulio Leo
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Moden
| | - Marco Vitolo
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Moden
- Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia
| | - Daniel Monopoli
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Moden
| | - Nicola Forzati
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Moden
| | - Valerio Siena
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Moden
| | - Matteo Menozzi
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Moden
| | - Paolo Cataldo
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Moden
| | - Marco Stuani
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Moden
| | - Vernizia Morgante
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Moden
| | | | | | | | - Giorgio Benatti
- Cardiology Division, Parma University Hospital, Parma, Italy
| | - Luigi Vignali
- Cardiology Division, Parma University Hospital, Parma, Italy
| | - Rosario Rossi
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Moden
| | - Giuseppe Boriani
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Moden
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18
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Hirasawa K, Butcher SC, Pereira AR, Meucci MC, Stassen J, van Rosendael P, Marsan NA, Bax JJ, Delgado V. Hemodynamic implications of mitral annular calcification in patients undergoing transcatheter aortic valve implantation for severe aortic stenosis. Int J Cardiovasc Imaging 2023; 39:2183-2192. [PMID: 37798420 PMCID: PMC10673730 DOI: 10.1007/s10554-023-02931-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Accepted: 08/08/2023] [Indexed: 10/07/2023]
Abstract
PURPOSES Predicting hemodynamic changes of stenotic mitral valve (MV) lesions with mitral annular calcification (MAC) following transcatheter aortic valve implantation (TAVI) may inform clinical decision-making. This study aimed to investigate the association between the MAC severity quantified by computed tomography (CT) and changes in mean transmitral gradient (mTMG), mitral valve area (MVA) and stroke volume index (SVi) following TAVI. METHODS AND RESULTS A total of 708 patients (median age 81, 52% male) with severe aortic stenosis (AS) underwent pre-procedural CT and pre- and post-TAVI transthoracic echocardiography. According to the classification of MAC severity determined by CT, 299 (42.2%) patients had no MAC, 229 (32.3%) mild MAC, 102 (14.4%) moderate MAC, and 78 (11.0%) severe MAC. After adjusting for age and sex, there was no significant change in mTMG following TAVI (Δ mTMG = 0.07 mmHg, 95% CI -0.10 to 0.23, P = 0.92) for patients with no MAC. In contrast, patients with mild MAC (Δ mTMG = 0.21 mmHg, 95% CI 0.01 to 0.40, P = 0.018), moderate MAC (Δ mTMG = 0.31 mmHg, 95% CI 0.02 to 0.60, P = 0.019) and severe MAC (Δ mTMG = 0.43 mmHg, 95% CI 0.10 to 0.76, P = 0.0012) had significant increases in mTMG following TAVI, with greater changes associated with increasing MAC severity. In contrast, there was no significant change in MVA or SVi following TAVI. CONCLUSION In patients with severe AS undergoing TAVI, MAC severity was associated with greater increases in post-procedural mTMG whereas MVA or SVi remained unchanged. MAC severity should be considered for potential subsequent MV interventions if TAVI does not improve symptoms.
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Affiliation(s)
- Kensuke Hirasawa
- Department of Cardiology, Leiden University Medical Center, Leiden, 2300RC, The Netherlands
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Steele C Butcher
- Department of Cardiology, Leiden University Medical Center, Leiden, 2300RC, The Netherlands
- Department of Cardiology, Royal Perth Hospital, Perth, WA, Australia
| | - Ana Rita Pereira
- Department of Cardiology, Leiden University Medical Center, Leiden, 2300RC, The Netherlands
- Department of Cardiology, Hospital Garcia de Orta, Almada, Portugal
| | - Maria Chiara Meucci
- Department of Cardiology, Leiden University Medical Center, Leiden, 2300RC, The Netherlands
- Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University of the Sacred Heart, Rome, Italy
| | - Jan Stassen
- Department of Cardiology, Leiden University Medical Center, Leiden, 2300RC, The Netherlands
| | - Philippe van Rosendael
- Department of Cardiology, Leiden University Medical Center, Leiden, 2300RC, The Netherlands
| | - Nina Ajmone Marsan
- Department of Cardiology, Leiden University Medical Center, Leiden, 2300RC, The Netherlands
| | - Jeroen J Bax
- Department of Cardiology, Leiden University Medical Center, Leiden, 2300RC, The Netherlands
- Heart Center, University of Turku, Turku University Hospital, Turku, Finland
| | - Victoria Delgado
- Department of Cardiology, Leiden University Medical Center, Leiden, 2300RC, The Netherlands.
- Department of Cardiology, Heart Lung Center, Albinusdreef 2, Leiden, 2300 RC, the Netherlands.
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19
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Doldi PM, Steffen J, Stolz L, Fischer J, Stocker TJ, Orban M, Theiss H, Rizas K, Sadoni S, Hagl C, Massberg S, Hausleiter J, Braun D, Deseive S. Impact of mitral regurgitation aetiology on the outcomes of transcatheter aortic valve implantation. EUROINTERVENTION 2023; 19:526-536. [PMID: 37042426 PMCID: PMC10440686 DOI: 10.4244/eij-d-22-01062] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 03/08/2023] [Indexed: 04/13/2023]
Abstract
BACKGROUND Concomitant moderate/severe mitral regurgitation (MR) is observed in 17-35% of patients undergoing transcatheter aortic valve implantation (TAVI) and contributes to a worse prognosis. Studies analysing outcomes in patients undergoing TAVI with different MR aetiologies, including atrial functional MR (aFMR), are lacking. AIMS We aimed to analyse outcomes and changes in MR severity in patients with aFMR, ventricular functional (vFMR) and primary mitral regurgitation (PMR) following TAVI. METHODS We analysed all consecutive patients with at least moderate MR undergoing TAVI between January 2013 and December 2020 at the Munich University Hospital. Characterisation of MR aetiology was performed by detailed individual echocardiographic assessment. Three-year mortality, changes in MR severity and New York Heart Association (NYHA) Functional Class at follow-up were assessed. RESULTS Out of 3,474 patients undergoing TAVI, 631 patients showed MR ≥2+ (172 with aFMR, 296 with vFMR, 163 with PMR). Procedural characteristics and endpoints were comparable between groups. The rate of MR improvement was 80.2% in aFMR patients, which was significantly higher compared to both other groups (vFMR: 69.4%; p=0.03; PMR: 40.8%; p<0.001). The estimated 3-year survival rates did not differ between aetiologies (p=0.57). However, MR persistence at follow-up was associated with increased mortality (hazard ratio 1.49, 95% confidence interval: 1.04-2.11; p=0.027), mainly driven by the PMR subgroup of patients. NYHA Class improved significantly in all groups. In patients with baseline MR ≥3+, the PMR aetiology was associated with the lowest MR improvement, the lowest survival rates and least symptomatic improvement. CONCLUSIONS TAVI reduces MR severity and symptoms in patients with aFMR, vFMR and less-pronounced PMR. The presence of aFMR was associated with the greatest MR severity improvement.
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Affiliation(s)
- Philipp Maximilian Doldi
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany
- Munich Heart Alliance, German Center for Cardiovascular Research (DZHK), Munich, Germany
| | - Julius Steffen
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany
- Munich Heart Alliance, German Center for Cardiovascular Research (DZHK), Munich, Germany
| | - Lukas Stolz
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany
| | - Julius Fischer
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany
| | - Thomas J Stocker
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany
- Munich Heart Alliance, German Center for Cardiovascular Research (DZHK), Munich, Germany
| | - Martin Orban
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany
- Munich Heart Alliance, German Center for Cardiovascular Research (DZHK), Munich, Germany
| | - Hans Theiss
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany
| | - Konstantinos Rizas
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany
- Munich Heart Alliance, German Center for Cardiovascular Research (DZHK), Munich, Germany
| | - Sebastian Sadoni
- Herzchirurgische Klinik und Poliklinik, Klinikum der Universität München, Munich, Germany
| | - Christian Hagl
- Herzchirurgische Klinik und Poliklinik, Klinikum der Universität München, Munich, Germany
| | - Steffen Massberg
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany
- Munich Heart Alliance, German Center for Cardiovascular Research (DZHK), Munich, Germany
| | - Jörg Hausleiter
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany
- Munich Heart Alliance, German Center for Cardiovascular Research (DZHK), Munich, Germany
| | - Daniel Braun
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany
- Munich Heart Alliance, German Center for Cardiovascular Research (DZHK), Munich, Germany
| | - Simon Deseive
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany
- Munich Heart Alliance, German Center for Cardiovascular Research (DZHK), Munich, Germany
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20
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Juarez-Casso FM, Crestanello JA. The Evolving Role of Surgical Aortic Valve Replacement in the Era of Transcatheter Valvular Procedures. J Clin Med 2023; 12:5299. [PMID: 37629341 PMCID: PMC10455383 DOI: 10.3390/jcm12165299] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 07/11/2023] [Accepted: 07/19/2023] [Indexed: 08/27/2023] Open
Abstract
Surgical aortic valve replacement (SAVR) has long been the standard treatment for severe symptomatic aortic stenosis (AS). However, transcatheter aortic valve replacement (TAVR) has emerged as a minimally invasive alternative; it was initially intended for high-risk patients and has now expanded its use to patients of all risk groups. While TAVR has demonstrated promising outcomes in diverse patient populations, uncertainties persist regarding its long-term durability and potential complications, raising the issue of the ideal lifetime management strategy for patients with AS. Therefore, SAVR continues to play an important role in clinical practice, particularly in younger patients with longer life expectancies, those with complex aortic anatomy who are unsuitable for TAVR, and those requiring concomitant surgical procedures. The choice between TAVR and SAVR warrants personalized decision-making, considering patient characteristics, comorbidities, anatomical considerations, and overall life expectancy. A multidisciplinary approach involving an experienced heart team is crucial in the preoperative evaluation process. In this review, we aimed to explore the current role of surgical management in addressing aortic valve stenosis amidst the expanding utilization of less invasive transcatheter procedures.
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Affiliation(s)
| | - Juan A. Crestanello
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN 55905, USA;
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21
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Hausleiter J, Stocker TJ, Adamo M, Karam N, Swaans MJ, Praz F. Mitral valve transcatheter edge-to-edge repair. EUROINTERVENTION 2023; 18:957-976. [PMID: 36688459 PMCID: PMC9869401 DOI: 10.4244/eij-d-22-00725] [Citation(s) in RCA: 45] [Impact Index Per Article: 22.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 11/04/2022] [Indexed: 01/21/2023]
Abstract
Mitral regurgitation (MR) is the most prevalent valvular heart disease and, when left untreated, results in reduced quality of life, heart failure, and increased mortality. Mitral valve transcatheter edge-to-edge repair (M-TEER) has matured considerably as a non-surgical treatment option since its commercial introduction in Europe in 2008. As a result of major device and interventional improvements, as well as the accumulation of experience by the interventional cardiologists, M-TEER has emerged as an important therapeutic strategy for patients with severe and symptomatic MR in the current European and American guidelines. Herein, we provide a comprehensive up-do-date overview of M-TEER. We define preprocedural patient evaluation and highlight key aspects for decision-making. We describe the currently available M-TEER systems and summarise the evidence for M-TEER in both primary mitral regurgitation (PMR) and secondary mitral regurgitation (SMR). In addition, we provide recommendations for device selection, intraprocedural imaging and guiding, M-TEER optimisation and management of recurrent MR. Finally, we provide information on major unsolved questions and "grey areas" in M-TEER.
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Affiliation(s)
- Jörg Hausleiter
- Department of Cardiology, LMU Klinikum, Ludwig Maximilian University of Munich, Munich, Germany and DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
| | - Thomas J Stocker
- Department of Cardiology, LMU Klinikum, Ludwig Maximilian University of Munich, Munich, Germany and DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
| | - Marianna Adamo
- Cardiology and Cardiac Catheterization Laboratory, ASST Spedali Civili di Brescia and Department of Medical and Surgical Specialties, University of Brescia, Brescia, Italy
| | - Nicole Karam
- Paris Cardiovascular Research Center, INSERM and Cardiology Department, European Hospital Georges Pompidou, University of Paris, Paris, France
| | - Martin J Swaans
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, the Netherlands
| | - Fabien Praz
- Bern University Hospital, University of Bern, Bern, Switzerland
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22
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Gjini P, Kenes JF, Chandrasekhar M, Hansen R, Dharod A, Smith SC, Pu M, Upadhya B, Stacey RB. Prevalence and clinical associations of mitral and aortic regurgitation in patients with aortic stenosis. Echocardiography 2023; 40:37-44. [PMID: 36522828 PMCID: PMC10107545 DOI: 10.1111/echo.15503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 11/01/2022] [Accepted: 11/20/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Most guidelines directing clinicians to manage valve disease are directed at single valve lesions. Limited data exists to direct our understanding of how concomitant valve disease impacts the left ventricle (LV). METHODS We identified 2817 patients with aortic stenosis (AS) from the echocardiography laboratory database between September 2012 and June 2018 who had a LV ejection fraction (EF) ≥50%. LV mass, LV mass index, LV systolic pressure (systolic blood pressure + peak aortic gradient). Covariates were collected from the electronic medical record. Multi-variate analysis of covariance was used to generate adjusted comparisons. RESULTS Our population was 66% female, 17% African-American with a mean age of 65 years. Of note, 7.3% were noted to have significant (moderate/severe) aortic regurgitation (AR), and 11% had significant (moderate/severe) mitral regurgitation (MR). Adjusting for covariates at different levels, significant MR had a much stronger association with heart failure compared to those with significant AR (p < .001 vs. p = .313, respectively) at all levels of adjustment. Both significant mitral and AR exhibited an association with increasing left ventricular mass, even with adjustment for baseline demographics and clinical features (p < .001 vs. p = .007, respectively). CONCLUSION In patients with AS, 16% also experience at least moderate MR or AR. Further, significant MR has a stronger association with heart failure than significant AR, even though both increase left ventricular mass. Those with moderate AS and significant MR or AR experience similar or higher levels of heart failure compared to severe AS without regurgitation. Mixed valve disease merits further studies to direct longitudinal management.
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Affiliation(s)
- Petro Gjini
- Evans Department of Medicine, Boston University School of Medicine, Boston, Massachusetts, USA
| | | | | | - Ross Hansen
- Section of Cardiovascular Medicine, Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Ajay Dharod
- Section of Cardiovascular Medicine, Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Stephen C Smith
- Section of Cardiovascular Medicine, Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Min Pu
- Division of Cardiology, Albert Einstein School of Medicine, New York, New York, USA
| | - Bharathi Upadhya
- Section of Cardiovascular Medicine, Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Richard Brandon Stacey
- Section of Cardiovascular Medicine, Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
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23
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Alushi B, Ensminger S, Herrmann E, Balaban Ü, Bauer T, Beckmann A, Bleiziffer S, Möllmann H, Walther T, Bekeredjian R, Hamm C, Beyersdorf F, Baldus S, Boening A, Falk V, Thiele H, Frerker C, Lauten A. Concomitant mitral regurgitation in patients with low-gradient aortic stenosis: an analysis from the German Aortic Valve Registry. Clin Res Cardiol 2022; 111:1377-1386. [PMID: 35984497 PMCID: PMC9681685 DOI: 10.1007/s00392-022-02067-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Accepted: 07/06/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND Patients with severe aortic stenosis (AS) frequently presented mitral regurgitation (MR), which may interfere with the standard echocardiographic measurements of mean pressure gradient (MPG), flow velocity, and aortic valve area (AVA). AIMS Herein we investigated the prevalence and severity of MR in patients with severe AS and its role on the accuracy of the standard echocardiographic parameters of AS quantification. METHODS Of all patients with severe AS undergoing transcatheter or surgical aortic valve replacement enrolled in the German Aortic Registry from 2011 to 2017, 119,641 were included in this study. The population was divided based on the values of left ventricular ejection fraction ([LVEF] > 50%, LVEF 31-50%, and LVEF ≤ 30%] and AVA (0.80 to ≤ 1.00 cm2, 0.60 to < 0.80 cm2, 0.40 to < 0.60 cm2, and 0.20 to < 0.40 cm2). RESULTS Overall, 77,890 (65%) patients with mild to-moderate and 4262 (4%) with severe MR were compared with 37,489 (31%) patients without MR. Patients with mild-to-moderate and severe MR presented significantly lower mPG (ΔmPG [95%CI] - 1.694 mmHg [- 2.123 to - 1.265], p < 0.0001 and - 6.954 mmHg [- 7.725 to - 6.183], p < 0.0001, respectively), that increased with LVEF impairment. Conversely, AVA did not differ (severe versus no MR: ΔAVA [95%CI]: - 0.007cm2 [- 0.023 to 0.009], p = 0.973). Increasing MR severity was associated with significant mPG reduction throughout all AVA strata, causing a low-gradient pattern, that manifested since the early stages of severe AS (LVEF > 50%: AVA 0.80 to 1.00 cm2; LVEF 31-50%: AVA 0.60 to 0.80 cm2). CONCLUSIONS In patients with severe AS, concomitant MR is common, contributes to the onset of a low-gradient AS pattern, and affects the diagnostic accuracy of flow-dependent AVA measurements. In this setting, a multimodality, AVA-centric approach should be implemented. In patients with severe aortic stenosis, concomitant mitral regurgitation contributes to the onset of a low-gradient pattern, warranting a multimodality, and AVA-centric diagnostic approach.
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Affiliation(s)
- Brunilda Alushi
- Department of Cardiovascular Diseases, Campus Benjamin Franklin, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin and German Centre for Cardiovascular Research (DZHK) Berlin Site, Hindenburgdamm 30, 12200, Berlin, Germany.
- Department of Internal Medicine and Cardiology, Zollernalbklinik, Balingen, Germany.
| | - Stephan Ensminger
- Department of Cardiac and Thoracic Vascular Surgery, University Heart Center Lübeck, Lübeck, Germany
| | - Eva Herrmann
- Institute of Biostatistics and Mathematical Modelling at Goethe University, Frankfurt am Main, Germany
- German Center for Cardiovascular Research, (DZHK), Partner Site Rhine Main, Frankfurt am Main, Germany
| | - Ümniye Balaban
- Institute of Biostatistics and Mathematical Modelling at Goethe University, Frankfurt am Main, Germany
- German Center for Cardiovascular Research, (DZHK), Partner Site Rhine Main, Frankfurt am Main, Germany
| | - Timm Bauer
- Department of Cardiology, Sana Klinikum Offenbach, Offenbach, Germany
| | - Andreas Beckmann
- German Society for Thoracic and Cardiovascular Surgery, Langenbeck-Virchow-Haus, Berlin, Germany
| | - Sabine Bleiziffer
- Clinic for Thoracic and Cardiovascular Surgery, Herz- und Diabeteszentrum NRW, Ruhr Universität Bochum, Bad Oeynhausen, Germany
| | - Helge Möllmann
- Medizinische Klinik I, St.-Johannes-Hospital Dortmund, Dortmund, Germany
| | - Thomas Walther
- Department of Cardiac Surgery, Goethe University Hospital, Frankfurt am Main, Germany
| | | | - Christian Hamm
- Department of Cardiology, University Clinic Giessen, Giessen, Germany
| | - Friedhelm Beyersdorf
- Department of Cardiovascular Surgery, University Heart Centre Bad Krozingen, Freiburg, Germany
| | - Stephan Baldus
- Department of Cardiology, Koeln University Hospital, Koeln, Germany
| | - Andreas Boening
- Department of Thorax and Cardiovascular Surgery, University Clinic Giessen, Giessen, Germany
| | - Volkmar Falk
- Department of Interventional Cardiology, Helios Klinikum Erfurt, Erfurt, Germany
- Department of Cardiothoracic Surgery, Charité - Universitätsmedizin Berlin Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Holger Thiele
- Department of Cardiology, Heart Center Leipzig at University Leipzig and Leipzig Heart Institute, Leipzig, Germany
| | - Christian Frerker
- II. Department of Medicine, University Medical Center Schleswig-Holstein, Lübeck, Germany
| | - Alexander Lauten
- Department of Cardiovascular Diseases, Campus Benjamin Franklin, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin and German Centre for Cardiovascular Research (DZHK) Berlin Site, Hindenburgdamm 30, 12200, Berlin, Germany
- Department of Interventional Cardiology, Helios Klinikum Erfurt, Erfurt, Germany
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24
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Impact of Transcatheter Aortic Valve Implantation Among Patients With Co-existing Mild to Moderate Mitral Regurgitation. Am J Cardiol 2022; 177:84-89. [PMID: 35732551 DOI: 10.1016/j.amjcard.2022.04.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Revised: 04/21/2022] [Accepted: 04/27/2022] [Indexed: 11/22/2022]
Abstract
A subset of patients with severe aortic stenosis (AS) who are who underwent transcatheter aortic valve implantation (TAVI) also has mitral regurgitation (MR). Clinical outcomes in these patients with combined MR and AS have varied. The purpose of this study was to assess clinical outcomes and echocardiographic outcomes after TAVI in patients with preprocedural MR. A retrospective chart review from March 2018 to June 2020 identified all TAVI patients. Patients were assigned an MR class of mild, moderate, or severe based upon pre-TAVI transthoracic echocardiogram (TTE). Patients were excluded if they were discharged from the hospital and did not have a 6-month follow-up after TAVI. Clinical outcomes at 6 months included all-cause mortality, major adverse cardiovascular events, clinically significant bleeding, changes in ejection fraction (EF) category, and changes in MR severity. Of 118 included patients (age 76 ± 10 years, 79% male, 46% White), 33% had MR, with 26% being mild and 7% moderate MR. Before TAVI, AS + MR patients were more likely to have a reduced EF (<50%) by category compared with those with AS only (33.3% vs 8.8%, p = 0.01) but were more likely to show an increase in EF by category after TAVI (19.4% vs 5.5%, p = 0.039). No significant differences were observed between the 2 groups in terms of all-cause mortality (12.8 vs 5.1%, p = 0.14), major adverse cardiovascular events (17.9 vs 8.9%, p = 0.15), or clinically significant bleeding (10.3 vs 6.3%, p = 0.45). Patients with AS and co-existing MR experienced similar clinical outcomes at 6 months to those with AS only after TAVI. They were more likely to show increases in EF category 6 months after valve implantation. Our results support the conclusion that in addition to treating the aortic valve, TAVI also potentially benefits left ventricular function in the setting of mild or moderate MR.
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Tomey MI, Camaj A, Kini AS, Sharma SK. Aortic Valvuloplasty and Large‐Bore Percutaneous Arterial Access. Interv Cardiol 2022. [DOI: 10.1002/9781119697367.ch55] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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26
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Siddiqi TJ, Usman MS, Ahmed J, Shahid I, Ahmed W, Alkhouli M. Evaluating the effect of multivalvular disease on mortality after transcatheter aortic valve replacement for aortic stenosis: a meta-analysis and systematic review. Future Cardiol 2022; 18:487-496. [PMID: 35485390 DOI: 10.2217/fca-2021-0061] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aims: To determine the prognosis of multivalvular disease in patients undergoing transcatheter aortic valve replacement (TAVR) for severe aortic stenosis. Methods: Patients undergoing TAVR for aortic stenosis with covariate-adjusted risk of mortality associated with concomitant valve disease (mitral regurgitation [MR], mitral stenosis [MS] or tricuspid regurgitation [TR]) were included. Results: Moderate-to-severe MR was associated with increased mortality at 30 days (hazard ratio [HR]: 1.60; 95% CI: 1.11-2.30; p = 0.01) and 1 year (HR: 1.87; 95% CI: 1.22-2.87; p = 0.004). The presence of all-grade MS did not impact 30-day or 1-year mortality (HR, 30 days: 1.60; 95% CI: 0.71-3.63; p = 0.26; and HR, 1 year: 1.90; 95% CI: 0.98-3.69; p = 0.06); however, an increased risk of 1-year mortality (HR: 1.67; 95% CI: 1.03-2.70; p = 0.04) was observed with severe MS compared with no MS. Moderate-to-severe TR had a higher risk of all-cause mortality at 1 year (HR: 1.49; 95% CI: 1.24-1.78; p < 0.001) compared with no or mild TR. Conclusion: Moderate-to-severe MR or TR, and severe MS, significantly increase mid-term mortality after TAVR.
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Affiliation(s)
| | | | - Jawad Ahmed
- Department of Medicine, Dow University of Health Sciences, Karachi, 74200, Pakistan
| | - Izza Shahid
- Department of Medicine, Ziauddin Medical University, Karachi, 7500, Pakistan
| | - Warda Ahmed
- Medical College, Aga Khan University, Karachi, 74800, Pakistan
| | - Mohamad Alkhouli
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
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27
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Moldovan H, Popescu BŞ, Nechifor E, Badea A, Ciomaga I, Nica C, Zaharia O, Gheorghiță D, Broască M, Diaconu C, Parasca C, Chioncel O, Iliescu VA. Rare Cause of Severe Mitral Regurgitation after TAVI: Case Report and Literature Review. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:464. [PMID: 35454303 PMCID: PMC9031139 DOI: 10.3390/medicina58040464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 03/11/2022] [Accepted: 03/16/2022] [Indexed: 11/29/2022]
Abstract
Pre-procedure mitral regurgitation (MR) is a frequent coexistent finding in patients undergoing transcatheter aortic valve replacement (TAVR), and most of them (up to 55%) experience a significant improvement in MR after the procedure. Although seldom described, mitral valve perforation after TAVR is a potentially serious complication that physicians should be aware of, as moderate or severe MR in TAVR recipients is associated with a high early mortality rate. We herein describe the case of a 65-year-old man presenting with worsening heart failure symptoms 5 months after TAVR due to an intraprocedural anterior mitral leaflet perforation and discuss the diagnostic process and therapeutic course of the case. Furthermore, we draw attention to the essential role of echocardiography in the management of TAVR procedures, taking into account its ability in detecting early complications, and emphasize the value of CT as a main determinant to predict long-term MR improvement after TAVR and to assess the potential candidates for double valve repair with percutaneous techniques.
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Affiliation(s)
- Horațiu Moldovan
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania; (O.Z.); (C.D.); (O.C.); (V.A.I.)
- Bucharest Clinical Emergency Hospital, 014461 Bucharest, Romania; (B.-Ş.P.); (A.B.); (C.N.); (M.B.)
| | - Bogdan-Ştefan Popescu
- Bucharest Clinical Emergency Hospital, 014461 Bucharest, Romania; (B.-Ş.P.); (A.B.); (C.N.); (M.B.)
| | - Elena Nechifor
- Sanador Clinical Hospital, 011038 Bucharest, Romania; (E.N.); (I.C.)
| | - Aida Badea
- Bucharest Clinical Emergency Hospital, 014461 Bucharest, Romania; (B.-Ş.P.); (A.B.); (C.N.); (M.B.)
| | - Irina Ciomaga
- Sanador Clinical Hospital, 011038 Bucharest, Romania; (E.N.); (I.C.)
| | - Claudia Nica
- Bucharest Clinical Emergency Hospital, 014461 Bucharest, Romania; (B.-Ş.P.); (A.B.); (C.N.); (M.B.)
| | - Ondin Zaharia
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania; (O.Z.); (C.D.); (O.C.); (V.A.I.)
- ”Prof. Dr. Theodor Burghele” Clinical Hospital, 061344 Bucharest, Romania
| | - Daniela Gheorghiță
- Faculty of Materials Science and Engineering, Politehnica University of Bucharest, 060042 Bucharest, Romania
| | - Marian Broască
- Bucharest Clinical Emergency Hospital, 014461 Bucharest, Romania; (B.-Ş.P.); (A.B.); (C.N.); (M.B.)
| | - Camelia Diaconu
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania; (O.Z.); (C.D.); (O.C.); (V.A.I.)
- Bucharest Clinical Emergency Hospital, 014461 Bucharest, Romania; (B.-Ş.P.); (A.B.); (C.N.); (M.B.)
| | - Cătălina Parasca
- “Prof. Dr. C.C. Iliescu” Institute for Cardiovascular Diseases, 022328 Bucharest, Romania;
| | - Ovidiu Chioncel
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania; (O.Z.); (C.D.); (O.C.); (V.A.I.)
- “Prof. Dr. C.C. Iliescu” Institute for Cardiovascular Diseases, 022328 Bucharest, Romania;
| | - Vlad Anton Iliescu
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania; (O.Z.); (C.D.); (O.C.); (V.A.I.)
- “Prof. Dr. C.C. Iliescu” Institute for Cardiovascular Diseases, 022328 Bucharest, Romania;
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Kiriyama H, Daimon M. Is Concomitant Mitral Regurgitation With Severe Aortic Stenosis Benign or Malignant? Circ J 2022; 86:438-439. [PMID: 34421108 DOI: 10.1253/circj.cj-21-0606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
| | - Masao Daimon
- Department of Cardiovascular Medicine, The University of Tokyo
- Department of Clinical Laborator, The University of Tokyo
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29
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Pontone G, Marano R, Agricola E, Alushi B, Bartorelli A, Cameli M, Carrabba N, Esposito A, Faletti R, Francone M, Galea N, Golino P, Guglielmo M, Palmisano A, Petronio S, Petullà M, Pradella S, Ribichini F, Romeo F, Russo V, Scandura S, Schicchi N, Spaccarotella C, Tomai F, Centonze M, indolfi C. Recommendations in pre-procedural imaging assessment for transcatheter aortic valve implantation intervention. J Cardiovasc Med (Hagerstown) 2022; 23:216-227. [DOI: 10.2459/jcm.0000000000001293] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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30
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OUP accepted manuscript. Eur Heart J 2022; 43:2729-2750. [DOI: 10.1093/eurheartj/ehac105] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 02/22/2022] [Accepted: 02/01/2022] [Indexed: 11/12/2022] Open
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Kato N, Thaden JJ, Miranda WR, Scott CG, Sarano ME, Greason KL, Pellikka PA. Impact of aortic valve replacement for severe aortic stenosis on organic and functional mitral regurgitation. ESC Heart Fail 2021; 8:5482-5492. [PMID: 34652057 PMCID: PMC8712890 DOI: 10.1002/ehf2.13649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 08/26/2021] [Accepted: 09/25/2021] [Indexed: 11/10/2022] Open
Abstract
AIMS Concurrent mitral regurgitation (MR) influences treatment considerations in patients with severe aortic stenosis (sAS). Limited information exists regarding haemodynamic effects of sAS on MR severity and outcome of these patients. We assessed the impact of aortic valve replacement (AVR) on MR according to mechanism in patients with sAS and MR. METHODS AND RESULTS In patients with sAS who received surgical or transcatheter AVR from 2008 to 2017, those with effective mitral regurgitant orifice area (ERO) ≥ 10 mm2 prior to AVR were evaluated. The change in MR after AVR was considered significant when there was at least one grade difference. We compared the all-cause mortality of patients with and without improvement in MR. Of 234 patients with sAS and MR (age 80 ± 9 years, 52% male, ERO 19 ± 7 mm2 ), organic and functional MR were present in 166 (71%) and 68 (29%), respectively. MR improved in 136 (58%); improvement occurred with similar frequency in organic versus functional MR (59% and 57%, P = 0.88). Associated determinants were absence of atrial fibrillation in organic MR [odds ratio (OR) 2.09, 95% confidence interval (CI) 1.00-4.37; P = 0.049] and indexed aortic valve area (iAVA) ≤ 0.40 cm2 in functional MR (OR 3.28, 95% CI 1.13-9.47; P = 0.028). In the overall cohort, mitral annulus diameter < 3 cm (OR 1.74, 95% CI 1.02-2.97; P = 0.041) and QRS duration < 115 ms (OR 1.73, 95% CI 1.00-2.98; P = 0.049) were independently associated with improvement in MR. During median follow-up of 3.5 years, lack of improvement in MR was not associated with higher mortality in the overall cohort of patients with ERO ≥ 20 mm2 [adjusted hazard ratio (HR) 1.71, 95% CI 0.90-3.27; P = 0.10, adjusted for age, New York Heart Association III or IV, diabetes, and creatinine ≥ 2.0 mg/dL]. Lack of improvement in organic MR was associated with higher mortality (adjusted HR 3.36, 95% CI 1.40-8.05; P < 0.01). In patients with functional MR, change in MR was not associated with mortality (HR 1.24, 95% CI 0.44-3.47; P = 0.68). CONCLUSIONS In nearly 60% of patients with sAS and MR, MR improved after AVR, even in the majority of patients with organic MR. Absence of atrial fibrillation in organic MR, iAVA ≤ 0.40 cm2 in functional MR, and mitral annulus diameter < 3 cm and QRS duration < 115 ms in the overall population were associated with MR improvement. Post-operative improvement in organic MR was associated with better survival.
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Affiliation(s)
- Nahoko Kato
- Department of Cardiovascular MedicineMayo Clinic200 First Street SouthwestRochesterMNUSA
| | - Jeremy J. Thaden
- Department of Cardiovascular MedicineMayo Clinic200 First Street SouthwestRochesterMNUSA
| | - William R. Miranda
- Department of Cardiovascular MedicineMayo Clinic200 First Street SouthwestRochesterMNUSA
| | | | - Maurice E. Sarano
- Department of Cardiovascular MedicineMayo Clinic200 First Street SouthwestRochesterMNUSA
| | | | - Patricia A. Pellikka
- Department of Cardiovascular MedicineMayo Clinic200 First Street SouthwestRochesterMNUSA
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The Use of BASILICA Technique to Prevent Coronary Obstruction in a TAVI-TAVI Procedure. J Clin Med 2021; 10:jcm10235534. [PMID: 34884239 PMCID: PMC8658292 DOI: 10.3390/jcm10235534] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 11/15/2021] [Accepted: 11/23/2021] [Indexed: 01/01/2023] Open
Abstract
Transcatheter aortic valve implantation (TAVI) to manage structural bioprosthetic valve deterioration has been successful in mitigating the risk of a redo cardiac surgery. However, TAVI-in-TAVI is a complex intervention, potentially associated with feared complications such as coronary artery obstruction. Coronary obstruction risk is especially high when the previously implanted prosthesis had supra-annular leaflets and/or the distance between the prosthesis and the coronary ostia is short. The BASILICA technique (bioprosthetic or native aortic scallop intentional laceration to prevent iatrogenic coronary artery obstruction) was developed to prevent coronary obstruction during native or valve-in-valve interventions but has now also been considered for TAVI-in-TAVI interventions. Despite its utility, the technique requires a not so widely available toolbox. Herein, we discuss the TAVI-in-TAVI BASILICA technique and how to perform it using more widely available tools, which could spread its use.
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Tirado-Conte G, McInerney A, Jimenez-Quevedo P, Carnero M, Marroquin Donday LA, De Agustin A, Witberg G, Pozo E, Islas F, Marcos-Alberca P, Cobiella J, Koronowski R, Macaya C, Rodes-Cabau J, Nombela-Franco L. Managing the patient undergoing transcatheter aortic valve replacement with ongoing mitral regurgitation. Expert Rev Cardiovasc Ther 2021; 19:711-723. [PMID: 34275408 DOI: 10.1080/14779072.2021.1955347] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Significant mitral regurgitation (MR) frequently coexists in patients with severe symptomatic aortic stenosis undergoing transcatheter aortic valve replacement (TAVR). These patients have worse clinical outcomes than those with non-significant MR, especially if MR persists after treatment of the aortic stenosis. The optimal treatment approach for this challenging high-risk population is not well defined. AREAS COVERED This review aims to present the current literature on concomitant significant MR in the TAVR population, and to provide a comprehensive algorithmic approach for clinical decision-making in this challenging cohort of patients. EXPERT OPINION Concomitant mitral and aortic valve disease is a complex clinical entity. An exhaustive and comprehensive assessment of patient's clinical characteristics and mitral valve anatomy and function is required in order to assess the surgical risk, predict the MR response after AVR and evaluate the feasibility of percutaneous MV treatment if necessary. Further developments in transcatheter techniques will expand the indications for double valve treatment in operable and inoperable patients with concomitant significant MR and aortic stenosis.
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Affiliation(s)
- Gabriela Tirado-Conte
- Department of Cardiology, Unit of Interventional Cardiology, Cardiovascular Institute, Hospital Clínico San Carlos, Madrid, Spain
| | - Angela McInerney
- Department of Cardiology, Unit of Interventional Cardiology, Cardiovascular Institute, Hospital Clínico San Carlos, Madrid, Spain
| | - Pilar Jimenez-Quevedo
- Department of Cardiology, Unit of Interventional Cardiology, Cardiovascular Institute, Hospital Clínico San Carlos, Madrid, Spain
| | - Manuel Carnero
- Department of Cardiac Surgery, Cardiovascular Institute, Hospital Clínico San Carlos, Madrid, Spain
| | - Luis A Marroquin Donday
- Department of Cardiology, Unit of Interventional Cardiology, Cardiovascular Institute, Hospital Clínico San Carlos, Madrid, Spain
| | - Alberto De Agustin
- Department of Cardiology, Unit of Interventional Cardiology, Cardiovascular Institute, Hospital Clínico San Carlos, Madrid, Spain
| | - Guy Witberg
- Department of Cardiology, Rabin Medical Centre, Petach-Tikvav, Israel.,Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Eduardo Pozo
- Department of Cardiology, Unit of Interventional Cardiology, Cardiovascular Institute, Hospital Clínico San Carlos, Madrid, Spain
| | - Fabian Islas
- Department of Cardiology, Unit of Interventional Cardiology, Cardiovascular Institute, Hospital Clínico San Carlos, Madrid, Spain
| | - Pedro Marcos-Alberca
- Department of Cardiology, Unit of Interventional Cardiology, Cardiovascular Institute, Hospital Clínico San Carlos, Madrid, Spain
| | - Javier Cobiella
- Department of Cardiac Surgery, Cardiovascular Institute, Hospital Clínico San Carlos, Madrid, Spain
| | - Ran Koronowski
- Department of Cardiology, Rabin Medical Centre, Petach-Tikvav, Israel.,Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Carlos Macaya
- Department of Cardiology, Unit of Interventional Cardiology, Cardiovascular Institute, Hospital Clínico San Carlos, Madrid, Spain
| | | | - Luis Nombela-Franco
- Department of Cardiology, Unit of Interventional Cardiology, Cardiovascular Institute, Hospital Clínico San Carlos, Madrid, Spain
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34
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Collins JD. CT Assessment of the Mitral Annulus Predicts Improvement in Coexistent Mitral Regurgitation Following Transcatheter Aortic Valve Replacement. Radiology 2021; 301:103-104. [PMID: 34313478 DOI: 10.1148/radiol.2021211265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Jeremy D Collins
- From the Department of Radiology, 200 1st St SW, Rochester, MN 55905
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35
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Enta Y, Miyasaka M, Taguri M, Tada N, Hata M, Watanabe Y, Naganuma T, Yamawaki M, Yamanaka F, Shirai S, Ueno H, Mizutani K, Tabata M, Takagi K, Yamamoto M, Hayashida K. Patients' characteristics and mortality in urgent/emergent/salvage transcatheter aortic valve replacement: insight from the OCEAN-TAVI registry. Open Heart 2021; 7:openhrt-2020-001467. [PMID: 33318151 PMCID: PMC7737081 DOI: 10.1136/openhrt-2020-001467] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 11/18/2020] [Accepted: 11/20/2020] [Indexed: 11/30/2022] Open
Abstract
Objectives Patients’ backgrounds and clinical outcomes in urgent/emergent/salvage transcatheter aortic valve replacement (Em-TAVR) remain unclear. We investigated patient characteristics and the mortality in Em-TAVR and the predictors for the need for Em-TAVR. Methods We consecutively enrolled 1613 patients undergoing TAVR for severe aortic stenosis between October 2013 and July 2016 from the Optimised transCathEter vAlvular interventioN (OCEAN)-transcatheter aortic valve implantation (TAVI) registry. The urgency was based on the European System for Cardiac Operative Risk Evaluation II. Urgent, emergent or salvage were included with the Em-TAVR group and elective with the El-TAVR group. Results Em-TAVR was observed in 87 (5.4%) patients. A higher Clinical Frailty Scale (CFS), peripheral artery disease (PAD), hypoalbuminaemia, reduced left ventricular ejection fraction (LVEF) and preoperative at least moderate mitral regurgitation (MR) predicted the need for the Em-TAVR by the multivariate logistic regression analysis. The Em-TAVR group had the higher Society of Thoracic Surgeons Score (13.7 (IQR 8.2–21.0) vs 6.5 (IQR 4.6–9.2); p<0.001) and higher 30-day mortality (9.2% vs 1.3%; p<0.001) than the El-TAVR group. Accordingly, Kaplan-Meier analysis showed that the cumulative mortality was higher in the Em-TAVR group than that in the El-TAVR group (log-rank; p<0.001). However, Em-TAVR did not predict mortality in the multivariate Cox regression analysis. Conclusions Em-TAVR was performed in 5.4% of patients. Higher CFS, PAD, hypoalbuminaemia, reduced LVEF and preprocedural MR predicted the need for Em-TAVR. Em-TAVR was not a predictor for mortality in the multivariate analysis, suggesting that it is a reasonable treatment option.
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Affiliation(s)
- Yusuke Enta
- Cardiovascular Center, Sendai Kousei Hospital, Sendai, Miyagi, Japan
| | - Masaki Miyasaka
- Cardiovascular Center, Sendai Kousei Hospital, Sendai, Miyagi, Japan
| | - Masataka Taguri
- Cardiovascular Center, Sendai Kousei Hospital, Sendai, Miyagi, Japan.,Department of Biostatistics, Yokohama City University School of Medicine, Yokohama, Kanagawa, Japan
| | - Norio Tada
- Cardiovascular Center, Sendai Kousei Hospital, Sendai, Miyagi, Japan
| | - Masaki Hata
- Cardiovascular Center, Sendai Kousei Hospital, Sendai, Miyagi, Japan
| | - Yusuke Watanabe
- Cardiology, Teikyo University School of Medicine, Itabashi-ku, Tokyo, Japan
| | - Toru Naganuma
- Cardiology, New Tokyo Hospital, Matsudo, Chiba, Japan
| | - Masahiro Yamawaki
- Cardiology, Saiseikai Yokohama-City Eastern Hospital, Yokohama, Kanagawa, Japan
| | - Futoshi Yamanaka
- Cardiology, Shonan Kamakura General Hospital, Kamakura, Kanagawa, Japan
| | - Shinichi Shirai
- Cardiology, Kokura Memorial Hospital, Kitakyusyu, Fukuoka, Japan
| | - Hiroshi Ueno
- Cardiology, Toyama University Hospital, Toyama, Toyama, Japan
| | - Kazuki Mizutani
- Cardiovascular Medicine, Osaka City General Hospital, Osaka, Osaka, Japan
| | - Minoru Tabata
- Cardiovascular Surgery, Tokyo Bay Urayasu Ichikawa Medical Center, Urayasu, Chiba, Japan
| | - Kensuke Takagi
- Cardiology, Ogaki Municipal Hospital, Ogaki, Gifu, Japan
| | - Masanori Yamamoto
- Cardiology, Toyohashi Heart Center, Toyohashi, Aichi, Japan.,Cardiology, Nagoya Heart Center, Nagoya, Aichi, Japan
| | - Kentaro Hayashida
- Cardiology, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
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36
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Santis AD. Mitral Regurgitation and Transcatheter Aortic Valve Replacement: Are There Any Other Prognostic Implications? Arq Bras Cardiol 2021; 116:1070-1071. [PMID: 34133588 PMCID: PMC8288546 DOI: 10.36660/abc.20210392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Antonio de Santis
- Universidade de São Paulo Instituto do Coração - Unidade Clinica de Valvopatia , São Paulo , SP - Brasil
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da Cunha LDCBP, Guerios EE, da Cunha CLP, Carvalho LA, Lemos P, Sarmento-Leite R, Abizaid AA, Mangione JA, Oliveira AD, Siciliano A, Esteves V, de Brito FS. Relationship between Mitral Regurgitation and Transcatheter Aortic Valve Implantation: a Multi-Institutional Follow-up Study. Arq Bras Cardiol 2021; 116:1059-1069. [PMID: 34133587 PMCID: PMC8288547 DOI: 10.36660/abc.20190772] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2019] [Revised: 05/23/2020] [Accepted: 06/16/2020] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Mitral regurgitation (MR) is prevalent in patients undergoing transcatheter aortic valve implantation (TAVI). There are some controversies about the prognostic impact of MR in survival of TAVI patients. OBJECTIVE To examine the relationship between TAVI and MR in a patient population from the Brazilian TAVI Registry. METHODS Seven hundred and ninety-five patients from the Brazilian TAVI Registry were divided at baseline, discharge, and follow-up according to their MR grade as follows: absent/mild (AMMR) or moderate/severe (MSMR). They were subsequently regrouped according to their immediate and late changes in MR severity after TAVI as follows: no change, improved, or worsened MR. Predictors and prognostic impact on baseline as well as changes in MR severity were analyzed. Statistical significance was set at p < 0.05. RESULTS Baseline MSMR was present in 19.3% of patients and was a predictor of increased late mortality. Immediately after TAVI, 47.4 % of cases improved to AMMR, predicted by a higher Society of Thoracic Surgeons score and a higher grade of baseline aortic regurgitation. Upon follow-up, 9.2% of cases of AMMR worsened to MSMR, whereas 36.8% of cases of MSMR improved to AMMR. Lower baseline left ventricular ejection fraction (LVEF) and improvement in LVEF at follow-up were predictors of MR improvement. Progressive worsening of MR upon follow-up was an independent predictor of higher late mortality after TAVI (p = 0.005). CONCLUSIONS Baseline MSMR predicts late mortality after TAVI. Lower LVEF and improved LVEF at follow-up predict MR improvement after TAVI. Progressive worsening of MR severity at follow-up is an independent predictor of late mortality, which is a rare finding in the literature.
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Affiliation(s)
| | - Enio Eduardo Guerios
- Universidade Federal do ParanáHospital de ClínicasCuritibaPRBrasil Universidade Federal do Paraná - Hospital de Clínicas - UFPR, Curitiba , PR - Brasil
| | - Claudio Leinig Pereira da Cunha
- Universidade Federal do ParanáHospital de ClínicasCuritibaPRBrasil Universidade Federal do Paraná - Hospital de Clínicas - UFPR, Curitiba , PR - Brasil
| | - Luiz A. Carvalho
- Hospital Pró-CardíacoRio de JaneiroRJBrasil Hospital Pró-Cardíaco , Rio de Janeiro , RJ - Brasil
| | - Pedro Lemos
- Hospital Israelita Albert EinsteinSão PauloSPBrasil Hospital Israelita Albert Einstein , São Paulo , SP - Brasil
| | - Rogério Sarmento-Leite
- Instituto de CardiologiaPorto AlegreRSBrasil Instituto de Cardiologia , Porto Alegre , RS - Brasil
| | - Alexandre A. Abizaid
- Hospital Israelita Albert EinsteinSão PauloSPBrasil Hospital Israelita Albert Einstein , São Paulo , SP - Brasil
| | - José Antonio Mangione
- Hospital Beneficência Portuguesa de São PauloSão PauloSPBrasil Hospital Beneficência Portuguesa de São Paulo , São Paulo , SP - Brasil
| | | | - Alexandre Siciliano
- Hospital Israelita Albert EinsteinSão PauloSPBrasil Hospital Israelita Albert Einstein , São Paulo , SP - Brasil
| | - Vinicius Esteves
- Rede D’Or São LuizSão PauloSPBrasil Rede D’Or São Luiz , São Paulo , SP - Brasil
| | - Fábio Sândoli de Brito
- Universidade de São PauloInstituto do CoraçãoSão PauloSPBrasil Universidade de São Paulo Instituto do Coração , São Paulo , SP - Brasil
- Hospital Sírio-LibanêsSão PauloSPBrasil Hospital Sírio-Libanês , São Paulo , SP - Brasil
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Asgar AW, Jamart L. Out-of-Hospital Mortality Following TAVR: Decrypting the Enigma. JACC Cardiovasc Interv 2021; 14:275-277. [PMID: 33541538 DOI: 10.1016/j.jcin.2020.11.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 11/16/2020] [Indexed: 11/25/2022]
Affiliation(s)
- Anita W Asgar
- Division of Cardiology, Montreal Heart Institute, Université de Montreal, Montreal, Quebec, Canada.
| | - Laurent Jamart
- Division of Cardiology, Montreal Heart Institute, Université de Montreal, Montreal, Quebec, Canada
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Lind AY, Totzeck M, Rassaf T, Jánosi RA. [Aortic stenosis - Selection of the appropriate TAVR patient]. MMW Fortschr Med 2021; 163:46-53. [PMID: 33844225 DOI: 10.1007/s15006-021-9714-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Alexander Y Lind
- Klinik für Kardiologie und Angiologie, Westdeutsches Herz- und Gefäßzentrum,, UniversitätDuisburg-Essen, Hufelandstraße 55, D-45147, Essen, Germany
| | - Matthias Totzeck
- - Klinik f. Kardiologie u. Angilogie -, Westdt.Herz- u. Gefäßzentrum\/Univ.-Klinikum Essen, Hufelandstraße 55, 45147, Essen, Germany
| | - Tienush Rassaf
- - Universitätsklinikum Essen -, Westdt. Herz- u. Gefäßzentrum\/Klinik f. Kardiologie, Hufelandstr. 55, 45122, Essen, Germany
| | - R Alexander Jánosi
- Klinik für Kardiologie und Angiologie, Westdeutsches Herz- und Gefäßzentrum, Universität Duisburg-Essen, Hufelandstraße 55, D-45147, Essen, Germany
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40
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Silbiger JJ. Mitral Annular Calcification and Calcific Mitral Stenosis: Role of Echocardiography in Hemodynamic Assessment and Management. J Am Soc Echocardiogr 2021; 34:923-931. [PMID: 33857624 DOI: 10.1016/j.echo.2021.04.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 02/23/2021] [Accepted: 04/06/2021] [Indexed: 12/01/2022]
Abstract
As the life expectancy of the population continues to increase, mitral annular calcification has emerged as an important cause of mitral stenosis (MS), commonly referred to as calcific or degenerative MS. Mitral annular calcification results in valvular stenosis when calcification extends into the base of the mitral leaflet(s) and displaces the mitral valve hinge point(s) into the left ventricular inlet. Echocardiographic determination of mitral vale area is fraught with difficulties and often precludes using planimetry or the Hatle formula. Given the numerous confounders that affect transmitral flow in calcific MS, evaluation of lesion severity should incorporate flow-independent methods such as the continuity equation and the mitral valve dimensionless index. In light of the significant risks entailed, there is little enthusiasm for mitral valve replacement in patients with calcific MS. Transcatheter mitral valve replacement is generally offered on a compassionate use basis to patients deemed to be at high surgical risk.
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Li YM, Mei FY, Yao YJ, Tsauo JY, Peng Y, Chen M. Causes and predictors of readmission after transcatheter aortic valve implantation : A meta-analysis and systematic review. Herz 2021; 46:1-8. [PMID: 31807789 DOI: 10.1007/s00059-019-04870-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Revised: 09/13/2019] [Accepted: 11/11/2019] [Indexed: 02/05/2023]
Abstract
BACKGROUND Since readmission rate is an important clinical index to determine the quality of inpatient care and hospital performance, the aim of this study was to explain the causes and predictors of readmission following transcatheter aortic valve implantation (TAVI) at short-term and mid-term follow-up. METHODS AND RESULTS A systematic review and meta-analysis of all published articles from Embase, Pubmed/MEDLINE, and Ovid was carried out. In all, 10 studies including 52,702 patients were identified. The pooled estimate for the overall event rate was 0.15, and cardiovascular causes were the main reason for 30-day readmission (0.42, 95% confidence interval [CI]: 0.39-0.45). In addition, the pooled incidence of 1‑year readmission was 0.31, and cardiovascular events were still the main cause (0.41, 95% CI: 0.33-0.48). Patients with major and life-threatening bleeding, new permanent pacemaker implantation, and clinical heart failure were associated with a high risk for early readmission after TAVI. Moreover, an advanced (≥3) New York Heart Association classification, acute kidney injury, paravalvular leak, mitral regurgitation (≥ moderate), and major bleeding predicted unfavorable outcome to 1‑year readmission. Female gender and transfemoral TAVI was associated with a lower risk for unplanned rehospitalization. CONCLUSIONS This meta-analysis found cardiovascular factors to be the main causes for both 30-day and 1‑year rehospitalization. Heart failure represented the most common cardiovascular event at both short-term and mid-term follow-up. Several baseline characteristics and procedure-related factors were deemed unfavorable predictors of readmission. Importantly, transfemoral access and female gender were associated with a lower risk of readmission.
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Affiliation(s)
- Yi-Ming Li
- Department of Cardiology, West China Hospital, Sichuan University, 37 Guoxue Street, 610041, Chengdu, China
| | - Fu-Yang Mei
- Zhejiang Provincial People's Hospital, Hangzhou, China
| | - Yi-Jun Yao
- West China School of Medicine, Sichuan University, Chengdu, China
| | - Jia-Yu Tsauo
- Department of Cardiology, West China Hospital, Sichuan University, 37 Guoxue Street, 610041, Chengdu, China
| | - Yong Peng
- Department of Cardiology, West China Hospital, Sichuan University, 37 Guoxue Street, 610041, Chengdu, China
| | - Mao Chen
- Department of Cardiology, West China Hospital, Sichuan University, 37 Guoxue Street, 610041, Chengdu, China.
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Giannini C, Angelillis M, Fiorina C, Tamburino C, Bedogni F, Bruschi G, Montorfano M, Poli A, De Felice F, Reimers B, Branca L, Barbanti M, Testa L, Merlanti B, Petronio AS. Clinical impact and evolution of mitral regurgitation after TAVI using the new generation self-expandable valves. Int J Cardiol 2021; 335:85-92. [PMID: 33811960 DOI: 10.1016/j.ijcard.2021.03.071] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 10/31/2020] [Accepted: 03/29/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND Concomitant mitral regurgitation (MR) impaired prognosis in patients undergoing transcatheter aortic valve implantation (TAVI). It has been suggested that the use of first generation self-expandable valve in patients with significant MR is associated with worse outcome as compared with balloon expandable valve. However, the impact of newer generation transcatheter devices on MR has not been investigated so far. We aim to assess the prognostic impact of MR in patients undergoing TAVI with the first-generation vs. the latest generation of self-expandable valves. METHODS We analyzed 2964 consecutive patients who underwent TAVI. Patients were classified into 4 groups according to the degree of baseline MR and the generation of self expandable valve implanted. RESULTS Of 1234 patients with moderate or severe MR, 817 were treated with first generation and 417 patients with second generation valves. Whereas, of 1730 patients with no or mild MR, 1130 were treated with first generation and 600 patients with second generation valves. Although, concomitant moderate-severe MR was found to be an independent predictor of mortality after TAVI, the use of newer generation self expandable valves was associated with higher survival rate at 1 year irrespective of the degree of preprocedural MR. At multivariable analysis the use of newer generation valve was associated with MR improvement throughout 1 year follow-up. CONCLUSION Baseline moderate-severe MR is associated with an increase in mortality after TAVI. However, the degree of preprocedural MR doesn't impact survival when a second generation self expandable valve is used.
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Affiliation(s)
- C Giannini
- Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy.
| | - M Angelillis
- Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | | | - C Tamburino
- Ferrarotto Hospital, University of Catania, Catania, Italy
| | - F Bedogni
- Policlinico San Donato, San Donato, Italy
| | - G Bruschi
- "De Gasperis" Cardio Center ASST Niguarda Metropolitan Hospital, Milan, Italy
| | | | - A Poli
- Ospedale Civile, Legnano, Italy
| | | | - B Reimers
- Clinical Institute Humanitas, Rozzano, Milan, Italy
| | | | - M Barbanti
- Ferrarotto Hospital, University of Catania, Catania, Italy
| | - L Testa
- Policlinico San Donato, San Donato, Italy
| | - B Merlanti
- "De Gasperis" Cardio Center ASST Niguarda Metropolitan Hospital, Milan, Italy
| | - A S Petronio
- Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
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Anzai T, Sato T, Fukumoto Y, Izumi C, Kizawa Y, Koga M, Nishimura K, Ohishi M, Sakashita A, Sakata Y, Shiga T, Takeishi Y, Yasuda S, Yamamoto K, Abe T, Akaho R, Hamatani Y, Hosoda H, Ishimori N, Kato M, Kinugasa Y, Kubozono T, Nagai T, Oishi S, Okada K, Shibata T, Suzuki A, Suzuki T, Takagi M, Takada Y, Tsuruga K, Yoshihisa A, Yumino D, Fukuda K, Kihara Y, Saito Y, Sawa Y, Tsutsui H, Kimura T. JCS/JHFS 2021 Statement on Palliative Care in Cardiovascular Diseases. Circ J 2021; 85:695-757. [PMID: 33775980 DOI: 10.1253/circj.cj-20-1127] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Toshihisa Anzai
- Department of Cardiovascular Medicine, Hokkaido University Graduate School of Medicine
| | - Takuma Sato
- Department of Cardiovascular Medicine, Hokkaido University Graduate School of Medicine
| | - Yoshihiro Fukumoto
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kurume University School of Medicine
| | - Chisato Izumi
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Yoshiyuki Kizawa
- Department of Palliative Medicine, Kobe University Graduate School of Medicine
| | - Masatoshi Koga
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center
| | | | - Mitsuru Ohishi
- Department of Cardiovascular Medicine and Hypertension, Graduate School of Medical and Dental Sciences, Kagoshima University
| | - Akihiro Sakashita
- Department of Palliative Medicine, Kobe University Graduate School of Medicine
| | - Yasushi Sakata
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine
| | - Tsuyoshi Shiga
- Department of Clinical Pharmacology and Therapeutics, The Jikei University School of Medicine
| | | | - Satoshi Yasuda
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine
| | - Kazuhiro Yamamoto
- Department of Cardiovascular Medicine and Endocrinology and Metabolism, Tottori University Hospital
| | - Takahiro Abe
- Department of Cardiovascular Medicine, Hokkaido University Graduate School of Medicine
| | - Rie Akaho
- Department of Psychiatry, Tokyo Women's Medical University
| | - Yasuhiro Hamatani
- Department of Cardiology, National Hospital Organization Kyoto Medical Center
| | - Hayato Hosoda
- Department of Cardiovascular Medicine, Chikamori Hospital
| | - Naoki Ishimori
- Department of Community Heart Failure Healthcare and Pharmacy, Hokkaido University Graduate School of Medicine
| | - Mika Kato
- Nursing Department, Hokkaido University Hospital
| | - Yoshiharu Kinugasa
- Department of Cardiovascular Medicine and Endocrinology and Metabolism, Tottori University Hospital
| | - Takuro Kubozono
- Department of Cardiovascular Medicine and Hypertension, Graduate School of Medical and Dental Sciences, Kagoshima University
| | - Toshiyuki Nagai
- Department of Cardiovascular Medicine, Hokkaido University Graduate School of Medicine
| | - Shogo Oishi
- Department of Cardiovascular Medicine, Hyogo Brain and Heart Center
| | - Katsuki Okada
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine
| | - Tatsuhiro Shibata
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kurume University School of Medicine
| | - Atsushi Suzuki
- Department of Cardiology, Tokyo Women's Medical University
| | | | - Masahito Takagi
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center
| | - Yasuko Takada
- Nursing Department, National Cerebral and Cardiovascular Center
| | | | - Akiomi Yoshihisa
- Department of Cardiovascular Medicine, Fukushima Medical University
| | | | - Keiichi Fukuda
- Department of Cardiology, Keio University School of Medicine
| | | | - Yoshihiko Saito
- Department of Cardiovascular Medicine, Nara Medical University
| | - Yoshiki Sawa
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine
| | - Hiroyuki Tsutsui
- Department of Cardiovascular Medicine, Kyushu University Graduate School of Medical Sciences
| | - Takeshi Kimura
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine
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Pulmonary hypertension in aortic valve stenosis. Trends Cardiovasc Med 2020; 32:73-81. [DOI: 10.1016/j.tcm.2020.12.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 11/26/2020] [Accepted: 12/12/2020] [Indexed: 01/09/2023]
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Mauri V, Körber MI, Kuhn E, Schmidt T, Frerker C, Wahlers T, Rudolph TK, Baldus S, Adam M, Ten Freyhaus H. Prognosis of persistent mitral regurgitation in patients undergoing transcatheter aortic valve replacement. Clin Res Cardiol 2020; 109:1261-1270. [PMID: 32072263 PMCID: PMC7515951 DOI: 10.1007/s00392-020-01618-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Accepted: 02/04/2020] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The objective of this study was to assess imaging predictors of mitral regurgitation (MR) improvement and to evaluate the impact of MR regression on long-term outcome in patients undergoing transcatheter aortic valve replacement (TAVR). BACKGROUND Concomitant MR is a frequent finding in patients with severe aortic stenosis but usually left untreated at the time of TAVR. METHODS Mitral regurgitation was graded by transthoracic echocardiography before and after TAVR in 677 consecutive patients with severe aortic stenosis. 2-year mortality was related to the degree of baseline and discharge MR. Morphological echo analysis was performed to determine predictors of MR improvement. RESULTS 15.2% of patients presented with baseline MR ≥ 3 +, which was associated with a significantly decreased 2-year survival (57.7% vs. 74.4%, P < 0.001). MR improved in 50% of patients following TAVR, with 44% regressing to MR ≤ 2 +. MR improvement to ≤ 2 + was associated with significantly better survival compared to patients with persistent MR ≥ 3 +. Baseline parameters including non-severe baseline MR, the extent of mitral annular calcification and large annular dimension (≥ 32 mm) predicted the likelihood of an improvement to MR ≤ 2 +. A score based on these parameters selected groups with differing probability of MR ≤ 2 + post TAVR ranging from 10.5 to 94.4% (AUC 0.816; P < 0.001), and was predictive for 2-year mortality. CONCLUSION Unresolved severe MR is a critical determinant of long term mortality following TAVR. Persistence of severe MR following TAVR can be predicted using selected parameters derived from TTE-imaging. These data call for close follow up and additional mitral valve treatment in this subgroup. Factors associated with MR persistence or regression after TAVR.
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Affiliation(s)
- Victor Mauri
- Department of Cardiology, Heart Center, University of Cologne, Kerpener Str. 61, 50937, Cologne, Germany.
| | - Maria I Körber
- Department of Cardiology, Heart Center, University of Cologne, Kerpener Str. 61, 50937, Cologne, Germany
| | - Elmar Kuhn
- Department of Cardiothoracic Surgery, Heart Center, University of Cologne, Cologne, Germany
| | - Tobias Schmidt
- Department of Cardiology, Heart Center, University of Cologne, Kerpener Str. 61, 50937, Cologne, Germany
| | - Christian Frerker
- Department of Cardiology, Heart Center, University of Cologne, Kerpener Str. 61, 50937, Cologne, Germany
| | - Thorsten Wahlers
- Department of Cardiothoracic Surgery, Heart Center, University of Cologne, Cologne, Germany
| | - Tanja K Rudolph
- Department of General and Interventional Cardiology, Ruhr-University Bochum, Heart- and Diabetes Center Nordrhein-Westfalen, Bad Oeynhausen, Germany
| | - Stephan Baldus
- Department of Cardiology, Heart Center, University of Cologne, Kerpener Str. 61, 50937, Cologne, Germany
| | - Matti Adam
- Department of Cardiology, Heart Center, University of Cologne, Kerpener Str. 61, 50937, Cologne, Germany
| | - Henrik Ten Freyhaus
- Department of Cardiology, Heart Center, University of Cologne, Kerpener Str. 61, 50937, Cologne, Germany
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Meyer A, Greve D, Unbehaun A, Kofler M, Kukucka M, Klein C, Knierim J, Emmert MY, Falk V, Kempfert J, Sündermann SH. Transcatheter aortic valve implantation and its impact on mitral valve geometry and function. J Card Surg 2020; 35:2185-2193. [PMID: 32652711 DOI: 10.1111/jocs.14734] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 05/07/2020] [Accepted: 05/07/2020] [Indexed: 01/11/2023]
Abstract
BACKGROUND The aim of this study was to evaluate the impact of transcatheter aortic valve implantation (TAVI) on mitral valve geometry and function. METHODS Eighty-four patients underwent TAVI. Forty-four (52%) patients received a balloon-expandable valve and 40 (48%) were implanted with a self-expandable valve. All patients underwent three-dimensional-volumetric transesophageal echocardiography of the mitral valve before and immediately after TAVI. A dedicated software was used for assisted semiautomatic measurement of mitral annular geometry. RESULTS During systole, the anterior to posterior (AP) diameter was significantly reduced after the procedure (3.4 ± 0.5 cm vs 3.2 ± 0.5 cm; P < .05). The mitral annular area (10.8 ± 2.8cm2 vs 9.9 ± 2.6cm2 ; P < .05) as well as the tenting area (1.6 ± 0.7 cm2 vs 1.2 ± 0.6 cm2 ; P < .001) measured at mid-systole were reduced after TAVI. Diastolic measures were similar. Patients treated with balloon-expandable valves showed a significantly larger reduction in the AP diameter compared to self-expandable valves (-0.25 cm vs -0.11 cm; P < .05). The reduction of the annular area was higher in the balloon-expandable group (-1.2 ± 1.59 vs -0.22 ± 1.41; P < .05). Grade of mitral regurgitation did improve or remained stable after TAVI. CONCLUSION TAVI significantly impacts the mitral valve and mitral annular geometry and morphology. The choice of the prosthesis (balloon- vs self-expandable) may be relevant for those changes.
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Affiliation(s)
- Alexander Meyer
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany.,Berlin Institute of Health, Berlin, Germany.,DZHK (German Center for Cardiovascular Research), partner site Berlin, Berlin, Germany
| | - Dustin Greve
- Department of Cardiovascular Surgery, Berlin Institute of Health, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlinand, Berlin, Germany
| | - Axel Unbehaun
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany.,DZHK (German Center for Cardiovascular Research), partner site Berlin, Berlin, Germany
| | - Markus Kofler
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany
| | - Marian Kukucka
- Institute of Anesthesiology, German Heart Center Berlin, Berlin, Germany
| | - Christoph Klein
- Department of Cardiology, German Heart Center Berlin, Berlin, Germany
| | - Jan Knierim
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany
| | - Maximilian Y Emmert
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany.,Department of Cardiovascular Surgery, Berlin Institute of Health, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlinand, Berlin, Germany
| | - Volkmar Falk
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany.,DZHK (German Center for Cardiovascular Research), partner site Berlin, Berlin, Germany.,Department of Cardiovascular Surgery, Berlin Institute of Health, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlinand, Berlin, Germany.,Department of Health Science Technology, Swiss Federal Institute of Technology, Zurich, Switzerland
| | - Jörg Kempfert
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany.,DZHK (German Center for Cardiovascular Research), partner site Berlin, Berlin, Germany
| | - Simon H Sündermann
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany.,DZHK (German Center for Cardiovascular Research), partner site Berlin, Berlin, Germany.,Department of Cardiovascular Surgery, Berlin Institute of Health, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlinand, Berlin, Germany
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47
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Wessler BS, Weintraub AR, Udelson JE, Kent DM. Can Clinical Predictive Models Identify Patients Who Should Not Receive TAVR? A Systematic Review. STRUCTURAL HEART-THE JOURNAL OF THE HEART TEAM 2020; 4:295-299. [PMID: 32905421 DOI: 10.1080/24748706.2020.1782549] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Background One third of high- and prohibitive-risk TAVR patients remain severely symptomatic or die 1 year after treatment. There is interest in identifying individuals for whom this procedure is futile and should not be offered. Methods We performed a systematic review of the highest reported stratum of risk in TAVR clinical predictive models (CPMs). We explore whether currently available predictive models can identify patients for whom TAVR is futile, based on a quantitative futility definition and the observed and predicted outcomes for patients in the highest stratum of risk. Results 17 TAVR CPMs representing 69,191 treated patients were published from 2013 to 2018. When reported, the median number of patients in the highest stratum of risk was 569 (range 1 to 1759). Observed mortality for this risk stratum ranged from 9% at 30 days to 59% at 1 year after TAVR. Statistical confidence in these observed event rates was low. The highest predicted event rates ranged from 11.0% for in-hospital mortality to 75.1% for the composite of mortality or high symptom burden 1 year after TAVR. Conclusion No high-risk TAVR group in currently available TAVR CPMs had an appropriate event rate and adequate statistical power to meet a quantitative definition of futility.
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Affiliation(s)
- Benjamin S Wessler
- Division of Cardiology and the CardioVascular Center, Tufts Medical Center.,Predictive Analytics and Comparative Effectiveness (PACE) Center, Tufts Medical Center
| | - Andrew R Weintraub
- Division of Cardiology and the CardioVascular Center, Tufts Medical Center
| | - James E Udelson
- Division of Cardiology and the CardioVascular Center, Tufts Medical Center
| | - David M Kent
- Predictive Analytics and Comparative Effectiveness (PACE) Center, Tufts Medical Center
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Khan F, Okuno T, Malebranche D, Lanz J, Praz F, Stortecky S, Windecker S, Pilgrim T. Transcatheter Aortic Valve Replacement in Patients With Multivalvular Heart Disease. JACC Cardiovasc Interv 2020; 13:1503-1514. [DOI: 10.1016/j.jcin.2020.03.052] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Revised: 02/07/2020] [Accepted: 03/13/2020] [Indexed: 12/21/2022]
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Role for Vascular Factors in Long-Term Outcomes After Transcatheter Aortic Valve Implantation. Am J Cardiol 2020; 125:1884-1889. [PMID: 32317099 DOI: 10.1016/j.amjcard.2020.03.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 03/07/2020] [Accepted: 03/10/2020] [Indexed: 01/01/2023]
Abstract
Despite major technological advances, 1-year morbi-mortality after transcatheter aortic valve implantation (TAVI) is still high. Further outcome improvements may be obtained provided proper identification of prognostic factors. A change of prognostic value over time should be the hallmark of an outcome-implicated factor. In 1,425 patients treated by TAVI, the examined prognostic factors were: demographic factors and co-morbidities (age, male gender, glomerular filtration rate, and chronic obstructive pulmonary disease), cardiac function (left ventricular ejection fraction, pulmonary pressure, aortic gradient, dyspnea, and mitral regurgitation), and vascular factors (coronary artery disease, peripheral vascular disease (PVD), previous stroke, and thoracic aortic calcium-TAC-as assessed by CT scan). Cox models were used to analyze cardiovascular and all-cause mortalities over 3 years of follow-up. The time-dependent effects of the factors were analyzed using the distribution of Schoenfeld residuals. During the study period, 375 (26.3%) deaths occurred of whom 248 (17.4%) from cardiovascular causes. Only 2 factors associated with cardiovascular or all-cause mortality showed significant changes over time: dyspnea and PVD. The effect of dyspnea on cardiovascular mortality decreased over time (first- and third-year hazard ratios [95% confidence intervals]: 1.47 [1.10; 1.96] and 0.94 [0.55; 1.63], respectively), whereas the effect of PVD increased (first- and third-year hazard ratios: 0.87 [0.56; 1.35] and 2.58 [1.25; 5.33], respectively). TAC had a stable effect. In conclusion, the detrimental effects of vascular factors remained stable (TAC) or increased (PVD) over time. These factors should be targeted by specific measures to improve post-TAVI outcomes.
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Lazar HL. Surgical Perspectives on Transcatheter Aortic Valve Replacement: The Sky Is Indeed Falling-For Now. Can J Cardiol 2020; 37:1-3. [PMID: 32497518 DOI: 10.1016/j.cjca.2020.02.077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2019] [Revised: 02/19/2020] [Accepted: 02/19/2020] [Indexed: 11/19/2022] Open
Affiliation(s)
- Harold L Lazar
- Division of Cardiac Surgery, Boston University School of Medicine, Boston, Massachusetts, USA.
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