Citations 2
The impact of pulmonary hypertension on outcomes of transcatheter mitral valve replacement in mitral annular calcification
Cajigas, Héctor , Kaptzan, Tatiana, Lewis, Bradley R., El‐Sabbagh, Abdallah, Al‐Hijji, Mohammed , Eleid, Mackram F. , Wang, Dee Dee , Eng, Marvin H. , Kodali, Susheel , Chakravarty, Tarun , O’Hair, Daniel, Jones, Noah, Makkar, Raj , Reisman, Mark, Leon, Martin B. , Rihal, Charanjit S. , Cajigas, Hector R , Eleid, Mackram F , Wang, Dee Dee , Pershad, Ashish , Rihal, Charanjit, Guerrero, Mayra E , Al-Hijji, Mohammed A , Alkhouli, Mohamad , George, Isaac , Pershad, Ashish , O’Neill, William W. , Rihal, Charanjit S. , Guerrero, Mayra
Catheterization and Cardiovascular Interventions | January 12, 2022 | Volume: 99 | Issue: 5 | Pages: 1647-1658
AbstractObjectivesTo assess the impact of pulmonary hypertension (PH) on outcomes of patients with severe mitral annular calcification (MAC) undergoing transcatheter mitral valve replacement (TMVR).BackgroundPH is associated with poor outcomes after mitral valve surgery. Whether the presence of PH in patients with MAC undergoing (TMVR) is associated with poor outcomes, is unknown.MethodsRetrospective evaluation of 116 patients from 51 centers in 11 countries who underwent TMVR with valve in mitral annular calcification (ViMAC) using balloon‐expandable aortic transcatheter valves (THVs) from September 2012 to March 2017. Pulmonary artery systolic blood pressure (PASP) by echocardiogram was available in 90 patients. The subjects were stratified based on PASP: No PH = PASP ≤35 mmHg (n = 11); mild to moderate PH = PASP 36–49 mmHg (n = 21) and severe PH = PASP ≥50 mmHg (n = 58). Clinical, procedural, and echocardiographic outcomes were assessed.ResultsMean age was 72.7 (±12.8) years, 59 (65.6%) were female, Society of Thoracic Surgeons score was 15.8 + 11.8% and 90.0% where in New York Heart Association (NYHA) class III–IV. There was no significant difference in all‐cause mortality at 30 days (no PH = 27.3%, mild–moderate PH = 19.0%, severe PH = 31.6%; p = 0.55) or at 1 year (no PH = 54.5%, mild–moderate PH = 38.1%, severe PH = 56.1%; p = 0.36). No difference in adverse events, NYHA class or amount of residual mitral regurgitation at 1 year were observed between the groups.ConclusionThis study suggests that the presence of PH in patients with predominantly mitral stenosis with MAC undergoing TMVR does not impact mortality or adverse events. Further studies are needed to fully understand the effect of PH in this group of patients.
Transcatheter Mitral Valve Replacement After Surgical Repair or Replacement
Simonato, Matheus , Ribeiro, Henrique Barbosa , Webb, John G. , Backer, Ole De , Villablanca, Pedro, Rihal, Charanjit S. , Eleid, Mackram F. , Kempfert, Jörg , Unbehaun, Axel , Erlebach, Magdalena , Casselman, Filip , Saia, Francesco , Ubben, Timm , Meincke, Felix , Napodano, Massimo, Codner, Pablo , Schöfer, Joachim, Pelletier, Marc , Cheung, Anson , Shuvy, Mony , Palma, José Honório , Duncan, Alison , Sinning, Jan-Malte, Arbel, Yaron , Weger, Arend de , Eltchaninoff, Hélène, Hemery, Thibault, Tchétché, Didier , Dumonteil, Nicolas, Rodés‐Cabau, Josep , Kim, Won-Keun, Spargias, Konstantinos, Kourkoveli, Panagiota, Ben‐Yehuda, Ori , Barbanti, Marco , Fiorina, Claudia , Thukkani, Arun K., Jones, Noah, Presbitero, Patrizia , Petronio, Anna Sonia , Champagnac, Didier , Rudolph, Tanja K. , Iadanza, Alessandro , Nombela‐Franco, Luis , Bonaros, Nikolaos , Kass, Malek , Amabile, Nicolas , Messina, Antonio , Andreas, Martin , Welsh, Robert C. , Schoels, Wolfgang , Hellig, Farrel, Windecker, Stephan , Stortecky, Stefan , Maisano, Francesco , Stone, Gregg W. , Dvir, Danny , Rihal, Charanjit, Eleid, Mackram, Nombela-Franco, Luis , Windecker, Stephan , Maisano, Francesco , De Backer, Ole , Whisenant, Brian K. , Kornowski, Ran , Guerrero, Mayra , Wijeysundera, Harindra C. , Søndergaard, Lars , Rihal, Charanjit S. , Adam, Matti , Montorfano, Matteo , Ancona, Marco , Gaia, Diego Felipe , Hildick-Smith, David , Veulemans, Verena , Sinning, Jan‐Malte, Testa, Luca , Landes, Uri , Kim, Won-Keun, Teles, Rui Campante , Mackensen, G. Burkhard , Allali, Abdelhakim , Bleiziffer, Sabine , Salizzoni, Stefano , Agrifoglio, Marco , Bruschi, Giuseppe , Chhatriwalla, Adnan K , Hirji, Sameer
Circulation | September 25, 2020 | Volume: 143 | Issue: 2 | Pages: 104-116
10.1161/circulationaha.120.049088
Background: Mitral valve-in-valve (ViV) and valve-in-ring (ViR) are alternatives to surgical reoperation in patients with recurrent mitral valve failure after previous surgical valve repair or replacement. Our aim was to perform a large-scale analysis examining midterm outcomes after mitral ViV and ViR. Methods: Patients undergoing mitral ViV and ViR were enrolled in the Valve-in-Valve International Data Registry. Cases were performed between March 2006 and March 2020. Clinical endpoints are reported according to the Mitral Valve Academic Research Consortium (MVARC) definitions. Significant residual mitral stenosis (MS) was defined as mean gradient ≥10 mm Hg and significant residual mitral regurgitation (MR) as ≥ moderate. Results: A total of 1079 patients (857 ViV, 222 ViR; mean age 73.5±12.5 years; 40.8% male) from 90 centers were included. Median STS-PROM score 8.6%; median clinical follow-up 492 days (interquartile range, 76–996); median echocardiographic follow-up for patients that survived 1 year was 772.5 days (interquartile range, 510–1211.75). Four-year Kaplan-Meier survival rate was 62.5% in ViV versus 49.5% for ViR ( P <0.001). Mean gradient across the mitral valve postprocedure was 5.7±2.8 mm Hg (≥5 mm Hg; 61.4% of patients). Significant residual MS occurred in 8.2% of the ViV and 12.0% of the ViR patients ( P =0.09). Significant residual MR was more common in ViR patients (16.6% versus 3.1%; P <0.001) and was associated with lower survival at 4 years (35.1% versus 61.6%; P =0.02). The rates of Mitral Valve Academic Research Consortium–defined device success were low for both procedures (39.4% total; 32.0% ViR versus 41.3% ViV; P =0.01), mostly related to having postprocedural mean gradient ≥5 mm Hg. Correlates for residual MS were smaller true internal diameter, younger age, and larger body mass index. The only correlate for residual MR was ViR. Significant residual MS (subhazard ratio, 4.67; 95% CI, 1.74–12.56; P =0.002) and significant residual MR (subhazard ratio, 7.88; 95% CI, 2.88–21.53; P <0.001) were both independently associated with repeat mitral valve replacement. Conclusions: Significant residual MS and/or MR were not infrequent after mitral ViV and ViR procedures and were both associated with a need for repeat valve replacement. Strategies to improve postprocedural hemodynamics in mitral ViV and ViR should be further explored.