Journal article
Transcatheter Mitral Valve Replacement for Degenerated Bioprosthetic Valves and Failed Annuloplasty Rings.
- Yoon SH Department of Interventional Cardiology, Cedars-Sinai Heart Institute, Los Angeles, California.
- Whisenant BK Division of Cardiovascular Diseases, Intermountain Heart Institute, Salt Lake City, Utah.
- Bleiziffer S Clinic for Cardiovascular Surgery, German Heart Center, Munich, Germany.
- Delgado V Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands.
- Schofer N Department of General and Interventional Cardiology, University Heart Center, Hamburg, Germany.
- Eschenbach L Clinic for Cardiovascular Surgery, German Heart Center, Munich, Germany.
- Fujita B Department of Thoracic and Cardiovascular Surgery, Heart and Diabetes Center NRW, Ruhr-University Bochum, Bad Oeynhausen, Germany.
- Sharma R Department of Interventional Cardiology, Cedars-Sinai Heart Institute, Los Angeles, California.
- Ancona M Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus & San Raffaele Scientific Institute, Milan, San Raffaele Hospital, Milan, Italy.
- Yzeiraj E Hamburg University Cardiovascular Center, Hamburg, Germany.
- Cannata S Department of Cardiology, St. Thomas' Hospital, London, United Kingdom.
- Barker C Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas.
- Davies JE Division of Cardiac and Thoracic Surgery, University of Alabama-Birmingham, Birmingham, Alabama.
- Frangieh AH Deutsches Herzzentrum München, Technische Universität München, Munich, Germany.
- Deuschl F Department of General and Interventional Cardiology, University Heart Center, Hamburg, Germany.
- Podlesnikar T Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands.
- Asami M Department of Cardiology, Bern University Hospital, Bern, Switzerland.
- Dhoble A Department of Cardiology, University of Texas Health Science Center, Houston, Texas.
- Chyou A Greenberg Division of Cardiology, New York-Presbyterian Hospital, Weil Cornell Medicine, New York, New York.
- Masson JB Division of Cardiology, Centre Hospitalier de l'université de Montreal, Montreal, Quebec, Canada.
- Wijeysundera HC Division of Cardiology, Sunnybrook Health Science Centre, Toronto, Ontario, Canada.
- Blackman DJ Cardiology Department, Leeds Teaching Hospital, Leeds, United Kingdom.
- Rampat R Sussex Cardiac Centre, Brighton and Sussex University Hospitals NHS Trust, Brighton, United Kingdom.
- Taramasso M University Heart Center, University Hospital Zurich, Zurich, Switzerland.
- Gutierrez-Ibanes E Department of Cardiology, Hospital General Universitario Gregorio Maranon, Madrid, Spain.
- Chakravarty T Department of Interventional Cardiology, Cedars-Sinai Heart Institute, Los Angeles, California.
- Attizzani GF The Valve and Structural Heart Interventional Center, University Hospitals Case Medical Center, Cleveland, Ohio.
- Kaneko T Division of Cardiac Surgery, Brigham and Women's Hospital, Boston, Massachusetts.
- Wong SC Greenberg Division of Cardiology, New York-Presbyterian Hospital, Weil Cornell Medicine, New York, New York.
- Sievert H Department of Cardiology and Vascular Medicine, CardioVascular Center, Frankfurt, Germany.
- Nietlispach F University Heart Center, University Hospital Zurich, Zurich, Switzerland.
- Hildick-Smith D Sussex Cardiac Centre, Brighton and Sussex University Hospitals NHS Trust, Brighton, United Kingdom.
- Nombela-Franco L Division of Cardiology, Hospital Clinicio San Carlos, Madrid, Spain.
- Conradi L Department of Cardiothoracic Surgery, University Heart Center Hamburg, Hamburg, Germany.
- Hengstenberg C Deutsches Herzzentrum München, Technische Universität München, Munich, Germany; German Center for Cardiovascular Research, Partner Site Munich Heart Alliance, Munich, Germany.
- Reardon MJ Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas.
- Kasel AM Deutsches Herzzentrum München, Technische Universität München, Munich, Germany.
- Redwood S Department of Cardiology, St. Thomas' Hospital, London, United Kingdom.
- Colombo A Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus & San Raffaele Scientific Institute, Milan, San Raffaele Hospital, Milan, Italy.
- Kar S Department of Interventional Cardiology, Cedars-Sinai Heart Institute, Los Angeles, California.
- Maisano F University Heart Center, University Hospital Zurich, Zurich, Switzerland.
- Windecker S Department of Cardiology, Bern University Hospital, Bern, Switzerland.
- Pilgrim T Department of Cardiology, Bern University Hospital, Bern, Switzerland.
- Ensminger SM Department of Thoracic and Cardiovascular Surgery, Heart and Diabetes Center NRW, Ruhr-University Bochum, Bad Oeynhausen, Germany.
- Prendergast BD Department of Cardiology, St. Thomas' Hospital, London, United Kingdom.
- Schofer J Hamburg University Cardiovascular Center, Hamburg, Germany.
- Schaefer U Department of General and Interventional Cardiology, University Heart Center, Hamburg, Germany.
- Bax JJ Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands.
- Latib A Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus & San Raffaele Scientific Institute, Milan, San Raffaele Hospital, Milan, Italy.
- Makkar RR Department of Interventional Cardiology, Cedars-Sinai Heart Institute, Los Angeles, California. Electronic address: raj.makkar@cshs.org.
- 2017-08-26
Published in:
- Journal of the American College of Cardiology. - 2017
annuloplasty ring
degenerated bioprostheses
mitral valve
transcatheter valve implantation
Aged
Bioprosthesis
Cardiac Catheterization
Europe
Female
Heart Valve Diseases
Heart Valve Prosthesis Implantation
Humans
Male
Mitral Valve
Mitral Valve Annuloplasty
North America
Prosthesis Design
Prosthesis Failure
Reoperation
Retrospective Studies
Survival Rate
Treatment Outcome
English
BACKGROUND
Limited data exist regarding transcatheter mitral valve replacement (TMVR) for patients with failed mitral valve replacement and repair.
OBJECTIVES
This study sought to evaluate the outcomes of TMVR in patients with failed mitral bioprosthetic valves (valve-in-valve [ViV]) and annuloplasty rings (valve-in-ring [ViR]).
METHODS
From the TMVR multicenter registry, procedural and clinical outcomes of mitral ViV and ViR were compared according to Mitral Valve Academic Research Consortium criteria.
RESULTS
A total of 248 patients with mean Society of Thoracic Surgeons score of 8.9 ± 6.8% underwent TMVR. Transseptal access and the balloon-expandable valve were used in 33.1% and 89.9%, respectively. Compared with 176 patients undergoing ViV, 72 patients undergoing ViR had lower left ventricular ejection fraction (45.6 ± 17.4% vs. 55.3 ± 11.1%; p < 0.001). Overall technical and device success rates were acceptable, at 92.3% and 85.5%, respectively. However, compared with the ViV group, the ViR group had lower technical success (83.3% vs. 96.0%; p = 0.001) due to more frequent second valve implantation (11.1% vs. 2.8%; p = 0.008), and lower device success (76.4% vs. 89.2%; p = 0.009) due to more frequent reintervention (16.7% vs. 7.4%; p = 0.03). Mean mitral valve gradients were similar between groups (6.4 ± 2.3 mm Hg vs. 5.8 ± 2.7 mm Hg; p = 0.17), whereas the ViR group had more frequent post-procedural mitral regurgitation moderate or higher (19.4% vs. 6.8%; p = 0.003). Furthermore, the ViR group had more frequent life-threatening bleeding (8.3% vs. 2.3%; p = 0.03), acute kidney injury (11.1% vs. 4.0%; p = 0.03), and subsequent lower procedural success (58.3% vs. 79.5%; p = 0.001). The 1-year all-cause mortality rate was significantly higher in the ViR group compared with the ViV group (28.7% vs. 12.6%; log-rank test, p = 0.01). On multivariable analysis, failed annuloplasty ring was independently associated with all-cause mortality (hazard ratio: 2.70; 95% confidence interval: 1.34 to 5.43; p = 0.005).
CONCLUSIONS
The TMVR procedure provided acceptable outcomes in high-risk patients with degenerated bioprostheses or failed annuloplasty rings, but mitral ViR was associated with higher rates of procedural complications and mid-term mortality compared with mitral ViV.
Limited data exist regarding transcatheter mitral valve replacement (TMVR) for patients with failed mitral valve replacement and repair.
OBJECTIVES
This study sought to evaluate the outcomes of TMVR in patients with failed mitral bioprosthetic valves (valve-in-valve [ViV]) and annuloplasty rings (valve-in-ring [ViR]).
METHODS
From the TMVR multicenter registry, procedural and clinical outcomes of mitral ViV and ViR were compared according to Mitral Valve Academic Research Consortium criteria.
RESULTS
A total of 248 patients with mean Society of Thoracic Surgeons score of 8.9 ± 6.8% underwent TMVR. Transseptal access and the balloon-expandable valve were used in 33.1% and 89.9%, respectively. Compared with 176 patients undergoing ViV, 72 patients undergoing ViR had lower left ventricular ejection fraction (45.6 ± 17.4% vs. 55.3 ± 11.1%; p < 0.001). Overall technical and device success rates were acceptable, at 92.3% and 85.5%, respectively. However, compared with the ViV group, the ViR group had lower technical success (83.3% vs. 96.0%; p = 0.001) due to more frequent second valve implantation (11.1% vs. 2.8%; p = 0.008), and lower device success (76.4% vs. 89.2%; p = 0.009) due to more frequent reintervention (16.7% vs. 7.4%; p = 0.03). Mean mitral valve gradients were similar between groups (6.4 ± 2.3 mm Hg vs. 5.8 ± 2.7 mm Hg; p = 0.17), whereas the ViR group had more frequent post-procedural mitral regurgitation moderate or higher (19.4% vs. 6.8%; p = 0.003). Furthermore, the ViR group had more frequent life-threatening bleeding (8.3% vs. 2.3%; p = 0.03), acute kidney injury (11.1% vs. 4.0%; p = 0.03), and subsequent lower procedural success (58.3% vs. 79.5%; p = 0.001). The 1-year all-cause mortality rate was significantly higher in the ViR group compared with the ViV group (28.7% vs. 12.6%; log-rank test, p = 0.01). On multivariable analysis, failed annuloplasty ring was independently associated with all-cause mortality (hazard ratio: 2.70; 95% confidence interval: 1.34 to 5.43; p = 0.005).
CONCLUSIONS
The TMVR procedure provided acceptable outcomes in high-risk patients with degenerated bioprostheses or failed annuloplasty rings, but mitral ViR was associated with higher rates of procedural complications and mid-term mortality compared with mitral ViV.
- Language
-
- English
- Open access status
- bronze
- Identifiers
-
- DOI 10.1016/j.jacc.2017.07.714
- PMID 28838360
- Persistent URL
- https://folia.unifr.ch/global/documents/178407
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