Transcatheter Treatment of Residual Significant Mitral Regurgitation Following TAVR: A Multicenter Registry |
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| Affiliation: | 1. Department of Cardiology, Rabin Medical Centre, Petach-Tikva, Israel;2. Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel;3. St. Paul’s Hospital, Vancouver, British Columbia, Canada;4. Division of Cardiology, University of Catania, Catania, Italy;5. The Heart Center, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark;6. Department of Cardiology, Thoraxcenter, Erasmus University Medical Center, Rotterdam, the Netherlands;7. Cardiovascular Center Frankfurt, Frankfurt, Germany;8. Department of Cardiovascular Medicine, Mayo Clinic Hospital, Rochester, Minnesota, USA;9. Cardiovascular Institute. Hospital Clinico San Carlos, IdISSC, Madrid, Spain;10. Department of Cardiology, Royal Victoria Hospital, Belfast Health & Social Care Trust, Belfast, United Kingdom;11. Herzzentrum Bonn Universitätsklinikum Bonn, Bonn, Germany;12. Department of Cardiac, Thoracic and Vascular Sciences, University of Padua Medical School, Padua, Italy;13. Division of Cardiac Surgery Medical University of Vienna, Vienna, Austria;14. Department of Medicine, Division of Cardiology, McGill University Health Centre, Royal Victoria Hospital, Montreal, Quebec, Canada;15. Department of Cardiology, Teikyo University School of Medicine, Tokyo, Japan;p. Department of Interventional Cardiology, San Raffaele Scientific Institute, Milan Italy;q. Department of Cardiology, University Hospital, and National University of Ireland Galway, Galway, Ireland;r. Department of Cardiology and Angiology II, University Heart Center Freiburg-Bad Krozingen, Bad Krozingen, Germany;s. Cardiovascular Department, Spedali Civili, Brescia, Italy;t. Hospital de Sant Creu i Sant Pau Barcelona, Barcelona, Spain;u. CIBERCV, Hospital Clínico Universitario de Valladolid, Valladolid, Spain;v. Department of Cardiology, University Hospital of León, León, Spain;w. Servicio de Cardiología, Hospital Álvaro Cunqueiro, Vigo, Pontevedra, Spain;x. Department of Interventional Cardiology, Clinique Pasteur, Toulouse, France;y. Anglia Ruskin University, Chelmsford, United Kingdom;z. University of California San Francisco, San Francisco, California, USA;11. Yunnan Hospital Fuwai, Kunming, China;22. Centre for Heart Valve Innovation, St. Paul’s Hospital, Vancouver, British Columbia, Canada |
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| Abstract: | ObjectivesThe aim of this study was to describe baseline characteristics, and periprocedural and mid-term outcomes of patients undergoing transcatheter mitral valve interventions post-transcatheter aortic valve replacement (TAVR) and examine their clinical benefit.BackgroundThe optimal management of residual mitral regurgitation (MR) post-TAVR is challenging.MethodsThis was an international registry of 23 TAVR centers.ResultsIn total, 106 of 24,178 patients (0.43%) underwent mitral interventions post-TAVR (100 staged, 6 concomitant), most commonly percutaneous edge-to-edge mitral valve repair (PMVR). The median interval post-TAVR was 164 days. Mean age was 79.5 ± 7.2 years, MR was >moderate in 97.2%, technical success was 99.1%, and 30-day device success rate was 88.7%. There were 18 periprocedural complications (16.9%) including 4 deaths. During a median follow-up of 464 days, the cumulative risk for 3-year mortality was 29.0%. MR grade and New York Heart Association (NYHA) functional class improved dramatically; at 1 year, MR was moderate or less in 90.9% of patients (mild or less in 69.1%), and 85.9% of patients were in NYHA functional class I/II. Staged PMVR was associated with lower mortality versus medical treatment (57.5% vs. 30.8%) in a propensity-matched cohort (n = 156), but this was not statistically significant (hazard ratio: 1.75; p = 0.05).ConclusionsFor patients who continue to have significant MR, remain symptomatic post-TAVR, and are anatomically suitable for transcatheter interventions, these interventions are feasible, safe, and associated with significant improvement in MR grade and NYHA functional class. These results apply mainly to PMVR. A staged PMVR strategy was associated with markedly lower mortality, but this was not statistically significant. (Transcatheter Treatment for Combined Aortic and Mitral Valve Disease. The Aortic+Mitral TRAnsCatheter Valve Registry [AMTRAC]; NCT04031274) |
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| Keywords: | aortic stenosis mitral regurgitation TAVR TMVR/r AS" },{" #name" :" keyword" ," $" :{" id" :" kwrd0035" }," $$" :[{" #name" :" text" ," _" :" aortic stenosis CI" },{" #name" :" keyword" ," $" :{" id" :" kwrd0045" }," $$" :[{" #name" :" text" ," _" :" confidence interval HR" },{" #name" :" keyword" ," $" :{" id" :" kwrd0055" }," $$" :[{" #name" :" text" ," _" :" hazard ratio IQR" },{" #name" :" keyword" ," $" :{" id" :" kwrd0065" }," $$" :[{" #name" :" text" ," _" :" interquartile range MR" },{" #name" :" keyword" ," $" :{" id" :" kwrd0075" }," $$" :[{" #name" :" text" ," _" :" mitral regurgitation NYHA" },{" #name" :" keyword" ," $" :{" id" :" kwrd0085" }," $$" :[{" #name" :" text" ," _" :" New York Heart Association PMVR" },{" #name" :" keyword" ," $" :{" id" :" kwrd0095" }," $$" :[{" #name" :" text" ," _" :" percutaneous edge-to-edge mitral valve repair PSM" },{" #name" :" keyword" ," $" :{" id" :" kwrd0105" }," $$" :[{" #name" :" text" ," _" :" propensity score matching SAVR" },{" #name" :" keyword" ," $" :{" id" :" kwrd0115" }," $$" :[{" #name" :" text" ," _" :" surgical aortic valve replacement TAVR" },{" #name" :" keyword" ," $" :{" id" :" kwrd0125" }," $$" :[{" #name" :" text" ," _" :" transcatheter aortic valve replacement TMVR" },{" #name" :" keyword" ," $" :{" id" :" kwrd0135" }," $$" :[{" #name" :" text" ," _" :" transcatheter mitral valve replacement TMVr" },{" #name" :" keyword" ," $" :{" id" :" kwrd0145" }," $$" :[{" #name" :" text" ," _" :" transcatheter mitral valve repair TMVR/r" },{" #name" :" keyword" ," $" :{" id" :" kwrd0155" }," $$" :[{" #name" :" text" ," _" :" transcatheter mitral valve replacement or repair VARC" },{" #name" :" keyword" ," $" :{" id" :" kwrd0165" }," $$" :[{" #name" :" text" ," _" :" Valve Academic Research Consortium |
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