Outcomes of transcatheter mitral valve replacement for degenerated bioprostheses, failed annuloplasty rings, and mitral annular calcification

TY - JOUR

T1 - Outcomes of transcatheter mitral valve replacement for degenerated bioprostheses, failed annuloplasty rings, and mitral annular calcification

AU - Yoon, Sung-Han

AU - Whisenant, Brian K

AU - Bleiziffer, Sabine

AU - Delgado, Victoria

AU - Dhoble, Abhijeet

AU - Schofer, Niklas

AU - Eschenbach, Lena

AU - Bansal, Eric

AU - Murdoch, Dale J

AU - Ancona, Marco

AU - Schmidt, Tobias

AU - Yzeiraj, Ermela

AU - Vincent, Flavien

AU - Niikura, Hiroki

AU - Kim, Won-Keun

AU - Asami, Masahiko

AU - Unbehaun, Axel

AU - Hirji, Sameer

AU - Fujita, Buntaro

AU - Silaschi, Miriam

AU - Tang, Gilbert H L

AU - Kuwata, Shingo

AU - Wong, S Chiu

AU - Frangieh, Antonio H

AU - Barker, Colin M

AU - Davies, James E

AU - Lauten, Alexander

AU - Deuschl, Florian

AU - Nombela-Franco, Luis

AU - Rampat, Rajiv

AU - Nicz, Pedro Felipe Gomes

AU - Masson, Jean-Bernard

AU - Wijeysundera, Harindra C

AU - Sievert, Horst

AU - Blackman, Daniel J

AU - Gutierrez-Ibanes, Enrique

AU - Sugiyama, Daisuke

AU - Chakravarty, Tarun

AU - Hildick-Smith, David

AU - de Brito, Fabio Sandoli

AU - Jensen, Christoph

AU - Jung, Christian

AU - Smalling, Richard W

AU - Arnold, Martin

AU - Redwood, Simon

AU - Kasel, Albert Markus

AU - Maisano, Francesco

AU - Treede, Hendrik

AU - Ensminger, Stephan M

AU - Kar, Saibal

AU - Kaneko, Tsuyoshi

AU - Pilgrim, Thomas

AU - Sorajja, Paul

AU - Van Belle, Eric

AU - Prendergast, Bernard D

AU - Bapat, Vinayak

AU - Modine, Thomas

AU - Schofer, Joachim

AU - Frerker, Christian

AU - Kempfert, Joerg

AU - Attizzani, Guilherme F

AU - Latib, Azeem

AU - Schaefer, Ulrich

AU - Webb, John G

AU - Bax, Jeroen J

AU - Makkar, Raj R

PY - 2019/2/1

Y1 - 2019/2/1

N2 - Aims: We sought to evaluate the outcomes of transcatheter mitral valve replacement (TMVR) for patients with degenerated bioprostheses [valve-in-valve (ViV)], failed annuloplasty rings [valve-in-ring (ViR)], and severe mitral annular calcification [valve-in-mitral annular calcification (ViMAC)].Methods and results: From the TMVR multicentre registry, procedural and clinical outcomes of ViV, ViR, and ViMAC were compared according to Mitral Valve Academic Research Consortium (MVARC) criteria. A total of 521 patients with mean Society of Thoracic Surgeons score of 9.0 ± 7.0% underwent TMVR (322 patients with ViV, 141 with ViR, and 58 with ViMAC). Trans-septal access and the Sapien valves were used in 39.5% and 90.0%, respectively. Overall technical success was excellent at 87.1%. However, left ventricular outflow tract obstruction occurred more frequently after ViMAC compared with ViR and ViV (39.7% vs. 5.0% vs. 2.2%; P < 0.001), whereas second valve implantation was more frequent in ViR compared with ViMAC and ViV (12.1% vs. 5.2% vs. 2.5%; P < 0.001). Accordingly, technical success rate was higher after ViV compared with ViR and ViMAC (94.4% vs. 80.9% vs. 62.1%; P < 0.001). Compared with ViMAC and ViV groups, ViR group had more frequent post-procedural mitral regurgitation ≥moderate (18.4% vs. 13.8% vs. 5.6%; P < 0.001) and subsequent paravalvular leak closure (7.8% vs. 0.0% vs. 2.2%; P = 0.006). All-cause mortality was higher after ViMAC compared with ViR and ViV at 30 days (34.5% vs. 9.9% vs. 6.2%; log-rank P < 0.001) and 1 year (62.8% vs. 30.6% vs. 14.0%; log-rank P < 0.001). On multivariable analysis, patients with failed annuloplasty rings and severe MAC were at increased risk of mortality after TMVR [ViR vs. ViV, hazard ratio (HR) 1.99, 95% confidence interval (CI) 1.27-3.12; P = 0.003; ViMAC vs. ViV, HR 5.29, 95% CI 3.29-8.51; P < 0.001].Conclusion: The TMVR provided excellent outcomes for patients with degenerated bioprostheses despite high surgical risk. However, ViR and ViMAC were associated with higher rates of adverse events and mid-term mortality compared with ViV.

AB - Aims: We sought to evaluate the outcomes of transcatheter mitral valve replacement (TMVR) for patients with degenerated bioprostheses [valve-in-valve (ViV)], failed annuloplasty rings [valve-in-ring (ViR)], and severe mitral annular calcification [valve-in-mitral annular calcification (ViMAC)].Methods and results: From the TMVR multicentre registry, procedural and clinical outcomes of ViV, ViR, and ViMAC were compared according to Mitral Valve Academic Research Consortium (MVARC) criteria. A total of 521 patients with mean Society of Thoracic Surgeons score of 9.0 ± 7.0% underwent TMVR (322 patients with ViV, 141 with ViR, and 58 with ViMAC). Trans-septal access and the Sapien valves were used in 39.5% and 90.0%, respectively. Overall technical success was excellent at 87.1%. However, left ventricular outflow tract obstruction occurred more frequently after ViMAC compared with ViR and ViV (39.7% vs. 5.0% vs. 2.2%; P < 0.001), whereas second valve implantation was more frequent in ViR compared with ViMAC and ViV (12.1% vs. 5.2% vs. 2.5%; P < 0.001). Accordingly, technical success rate was higher after ViV compared with ViR and ViMAC (94.4% vs. 80.9% vs. 62.1%; P < 0.001). Compared with ViMAC and ViV groups, ViR group had more frequent post-procedural mitral regurgitation ≥moderate (18.4% vs. 13.8% vs. 5.6%; P < 0.001) and subsequent paravalvular leak closure (7.8% vs. 0.0% vs. 2.2%; P = 0.006). All-cause mortality was higher after ViMAC compared with ViR and ViV at 30 days (34.5% vs. 9.9% vs. 6.2%; log-rank P < 0.001) and 1 year (62.8% vs. 30.6% vs. 14.0%; log-rank P < 0.001). On multivariable analysis, patients with failed annuloplasty rings and severe MAC were at increased risk of mortality after TMVR [ViR vs. ViV, hazard ratio (HR) 1.99, 95% confidence interval (CI) 1.27-3.12; P = 0.003; ViMAC vs. ViV, HR 5.29, 95% CI 3.29-8.51; P < 0.001].Conclusion: The TMVR provided excellent outcomes for patients with degenerated bioprostheses despite high surgical risk. However, ViR and ViMAC were associated with higher rates of adverse events and mid-term mortality compared with ViV.

KW - Aged

KW - Aged, 80 and over

KW - Bioprosthesis

KW - Calcinosis/surgery

KW - Female

KW - Heart Valve Prosthesis

KW - Heart Valve Prosthesis Implantation/adverse effects

KW - Humans

KW - Male

KW - Middle Aged

KW - Mitral Valve/pathology

KW - Mitral Valve Annuloplasty/adverse effects

KW - Postoperative Complications/epidemiology

KW - Prosthesis Design

KW - Prosthesis Failure

KW - Stroke/etiology

KW - Treatment Outcome

U2 - 10.1093/eurheartj/ehy590

DO - 10.1093/eurheartj/ehy590

M3 - SCORING: Journal article

C2 - 30357365

VL - 40

SP - 441

EP - 451

JO - EUR HEART J

JF - EUR HEART J

SN - 0195-668X

IS - 5

ER -