Transcatheter Mitral Valve Replacement for Degenerated Bioprosthetic Valves and Failed Annuloplasty Rings
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Transcatheter Mitral Valve Replacement for Degenerated Bioprosthetic Valves and Failed Annuloplasty Rings. / Yoon, Sung-Han; Whisenant, Brian K; Bleiziffer, Sabine; Delgado, Victoria; Schofer, Niklas; Eschenbach, Lena; Fujita, Buntaro; Sharma, Rahul; Ancona, Marco; Yzeiraj, Ermela; Cannata, Stefano; Barker, Colin; Davies, James E; Frangieh, Antonio H; Deuschl, Florian; Podlesnikar, Tomaz; Asami, Masahiko; Dhoble, Abhijeet; Chyou, Anthony; Masson, Jean-Bernard; Wijeysundera, Harindra C; Blackman, Daniel J; Rampat, Rajiv; Taramasso, Maurizio; Gutierrez-Ibanes, Enrique; Chakravarty, Tarun; Attizzani, Guiherme F; Kaneko, Tsuyoshi; Wong, S Chiu; Sievert, Horst; Nietlispach, Fabian; Hildick-Smith, David; Nombela-Franco, Luis; Conradi, Lenard; Hengstenberg, Christian; Reardon, Michael J; Kasel, Albert Markus; Redwood, Simon; Colombo, Antonio; Kar, Saibal; Maisano, Francesco; Windecker, Stephan; Pilgrim, Thomas; Ensminger, Stephan M; Prendergast, Bernard D; Schofer, Joachim; Schaefer, Ulrich; Bax, Jeroen J; Latib, Azeem; Makkar, Raj R.
in: J AM COLL CARDIOL, Jahrgang 70, Nr. 9, 29.08.2017, S. 1121-1131.Publikationen: SCORING: Beitrag in Fachzeitschrift/Zeitung › SCORING: Zeitschriftenaufsatz › Forschung › Begutachtung
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TY - JOUR
T1 - Transcatheter Mitral Valve Replacement for Degenerated Bioprosthetic Valves and Failed Annuloplasty Rings
AU - Yoon, Sung-Han
AU - Whisenant, Brian K
AU - Bleiziffer, Sabine
AU - Delgado, Victoria
AU - Schofer, Niklas
AU - Eschenbach, Lena
AU - Fujita, Buntaro
AU - Sharma, Rahul
AU - Ancona, Marco
AU - Yzeiraj, Ermela
AU - Cannata, Stefano
AU - Barker, Colin
AU - Davies, James E
AU - Frangieh, Antonio H
AU - Deuschl, Florian
AU - Podlesnikar, Tomaz
AU - Asami, Masahiko
AU - Dhoble, Abhijeet
AU - Chyou, Anthony
AU - Masson, Jean-Bernard
AU - Wijeysundera, Harindra C
AU - Blackman, Daniel J
AU - Rampat, Rajiv
AU - Taramasso, Maurizio
AU - Gutierrez-Ibanes, Enrique
AU - Chakravarty, Tarun
AU - Attizzani, Guiherme F
AU - Kaneko, Tsuyoshi
AU - Wong, S Chiu
AU - Sievert, Horst
AU - Nietlispach, Fabian
AU - Hildick-Smith, David
AU - Nombela-Franco, Luis
AU - Conradi, Lenard
AU - Hengstenberg, Christian
AU - Reardon, Michael J
AU - Kasel, Albert Markus
AU - Redwood, Simon
AU - Colombo, Antonio
AU - Kar, Saibal
AU - Maisano, Francesco
AU - Windecker, Stephan
AU - Pilgrim, Thomas
AU - Ensminger, Stephan M
AU - Prendergast, Bernard D
AU - Schofer, Joachim
AU - Schaefer, Ulrich
AU - Bax, Jeroen J
AU - Latib, Azeem
AU - Makkar, Raj R
N1 - Copyright © 2017 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
PY - 2017/8/29
Y1 - 2017/8/29
N2 - 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.
AB - 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.
KW - Aged
KW - Bioprosthesis/adverse effects
KW - Cardiac Catheterization/methods
KW - Europe/epidemiology
KW - Female
KW - Heart Valve Diseases/surgery
KW - Heart Valve Prosthesis Implantation/methods
KW - Humans
KW - Male
KW - Mitral Valve/surgery
KW - Mitral Valve Annuloplasty/adverse effects
KW - North America/epidemiology
KW - Prosthesis Design
KW - Prosthesis Failure
KW - Reoperation
KW - Retrospective Studies
KW - Survival Rate/trends
KW - Treatment Outcome
U2 - 10.1016/j.jacc.2017.07.714
DO - 10.1016/j.jacc.2017.07.714
M3 - SCORING: Journal article
C2 - 28838360
VL - 70
SP - 1121
EP - 1131
JO - J AM COLL CARDIOL
JF - J AM COLL CARDIOL
SN - 0735-1097
IS - 9
ER -