Transcatheter aortic valve replacement in patients with severe mitral or tricuspid regurgitation at extreme risk for surgery |
| |
| Authors: | Stephen H. Little,Jeffrey J. Popma,Neal S. Kleiman,G. Michael Deeb,Thomas G. Gleason,Steven J. Yakubov,Stan Checuti,Daniel O&#x Hair,Tanvir Bajwa,Mubashir Mumtaz,Brijeshwar Maini,Alan Hartman,Stanley Katz,Newell Robinson,George Petrossian,John Heiser,William Merhi,B. Jane Moore,Michael J. Reardon |
| |
| Affiliation: | 1. Houston Methodist DeBakey Heart & Vascular Center, Departments of Cardiothoracic Surgery and Cardiology, Houston, Tex;2. Interventional Cardiology, Beth Israel Deaconess Medical Center, Boston, Mass;3. Departments of Cardiac Surgery and Interventional Cardiology, University of Michigan Hospitals, Ann Arbor, Mich;4. Department of Cardiothoracic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pa;5. Interventional Cardiology, Riverside Methodist Hospital, Columbus, Ohio;6. Departments of Cardiothoracic Surgery and Interventional Cardiology, St Luke''s Medical Center, Aurora Health Care, Milwaukee, Wis;7. Pinnacle Health Harrisburg Hospital, Harrisburg, Pa;8. Department of Intervention Cardiology, Delray Medical Center, Delray Beach, Fla;9. Departments of Cardiovascular Surgery and Interventional Cardiology, North Shore University Hospital, Manhasset, NY;10. Departments of Cardiothoracic and Vascular Surgery and Interventional Cardiology, St Francis Hospital, Roslyn, NY;11. Departments of Cardiothoracic Surgery and Interventional Cardiology, Spectrum Health Hospitals, Grand Rapids, Mich;12. Clinical Services and Statistical Services, Medtronic, Minneapolis, Minn;13. Department of Cardiovascular Surgery, Mount Sinai Health System, New York, NY |
| |
| Abstract: | ObjectivesPatients with symptomatic severe aortic stenosis and severe mitral regurgitation or severe tricuspid regurgitation were excluded from the major transcatheter aortic valve replacement trials. We studied these 2 subgroups in patients at extreme risk for surgery in the prospective, nonrandomized, single-arm CoreValve US Expanded Use Study.MethodsThe primary end point was all-cause mortality or major stroke at 1 year. A favorable medical benefit was defined as a Kansas City Cardiomyopathy Questionnaire overall summary score greater than 45 at 6 months and greater than 60 at 1 year and with a less than 10-point decrease from baseline.ResultsThere were 53 patients in each group. Baseline characteristics for the severe mitral regurgitation and severe tricuspid regurgitation cohorts were age 84.2 ± 6.4 years and 84.9 ± 6.5 years; male, 29 (54.7%) and 22 (41.5%), and mean Society of Thoracic Surgeons score 9.9% ± 5.0% and 9.2% ± 4.0%, respectively. Improvement in valve regurgitation from baseline to 1 year occurred in 72.7% of the patients with severe mitral regurgitation and in 61.8% of patients with severe tricuspid regurgitation. A favorable medical benefit occurred in 31 of 47 patients (66.0%) with severe mitral regurgitation and 33 of 47 patients (70.2%) with severe tricuspid regurgitation at 6 months, and in 25 of 44 patients (56.8%) with severe mitral regurgitation and 24 of 45 patients (53.3%) with severe tricuspid regurgitation at 1 year. All-cause mortality or major stroke for the severe mitral regurgitation and severe tricuspid regurgitation cohorts were 11.3% and 3.8% at 30 days and 21.0% and 19.2% at 1 year, respectively. There were no major strokes in either group at 1 year.ConclusionsTranscatheter aortic valve replacement in patients with severe mitral regurgitation or severe tricuspid regurgitation is reasonable and safe and leads to improvement in atrioventricular valve regurgitation. |
| |
| Keywords: | aortic stenosis transcatheter aortic valve replacement mitral valve regurgitation tricuspid valve regurgitation AS aortic stenosis ER extreme risk KCCQ-OSS Kansas City Cardiomyopathy Questionnaire Overall Summary Score MR mitral regurgitation SAVR surgical aortic valve replacement SMR severe mitral regurgitation STR severe tricuspid regurgitation TAVR transcatheter aortic valve replacement TR tricuspid regurgitation |
| 本文献已被 ScienceDirect 等数据库收录！ |
|
