TAVI in Patients with Mitral Annular Calcification and/or Mitral Stenosis
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TAVI in Patients with Mitral Annular Calcification and/or Mitral Stenosis. / Schaefer, Andreas; Sarwari, Harun; Schofer, Niklas; Schneeberger, Yvonne; Westermann, Dirk; Schoen, Gerhard; Blankenberg, Stefan; Reichenspurner, Hermann; Schäfer, Ulrich; Conradi, Lenard.
In: THORAC CARDIOV SURG, Vol. 69, No. 5, 08.2021, p. 428-436.Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review
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TY - JOUR
T1 - TAVI in Patients with Mitral Annular Calcification and/or Mitral Stenosis
AU - Schaefer, Andreas
AU - Sarwari, Harun
AU - Schofer, Niklas
AU - Schneeberger, Yvonne
AU - Westermann, Dirk
AU - Schoen, Gerhard
AU - Blankenberg, Stefan
AU - Reichenspurner, Hermann
AU - Schäfer, Ulrich
AU - Conradi, Lenard
N1 - Georg Thieme Verlag KG Stuttgart · New York.
PY - 2021/8
Y1 - 2021/8
N2 - BACKGROUND: We herein aimed for analysis of influence of mitral annular calcification (MAC) and mitral stenosis (MS) on outcomes in transcatheter aortic valve implantation (TAVI).METHODS: Between 11/2009 and 06/2017, 1,058 patients underwent TAVI in the presence of concomitant MAC or MS at our center. Subgroups were built and multivariate logistic regression, COX regression, Kaplan-Meier survival analyses, and receiver operating characteristics method were performed.RESULTS: Thirty-day mortality was 7.5% (79/1,058) with highest mortality in patients severe MS (MAC: 3.4% vs. mild MS: 5.9% vs. moderate MS: 15.0% vs. severe MS: 72.7%; p < 0.001). Moderate-to-severe MS (odds ratio [OR]: 7.75, confidence interval [CI]: 3.94-16.26, p < 0.001), impaired left ventricular ejection fraction (OR: 1.38, CI: 1.10-1.72, p < 0.01), and coronary artery disease (OR: 1.36, CI: 1.11-1.67, p < 0.01) were predictive of 30-day survival. Left ventricular systolic/end-diastolic pressure drop of <59.5 mm Hg / <19.5 mm Hg was associated with increased mortality.CONCLUSIONS: TAVI in the presence of MAC and mild MS is associated with acceptable acute outcomes but should be considered high-risk procedures in patients with moderate and especially those with severe MS. Our results suggest adverse hemodynamics after TAVI with concomitant MS, which may be caused by underfilling of the left ventricle leading to low-cardiac output.
AB - BACKGROUND: We herein aimed for analysis of influence of mitral annular calcification (MAC) and mitral stenosis (MS) on outcomes in transcatheter aortic valve implantation (TAVI).METHODS: Between 11/2009 and 06/2017, 1,058 patients underwent TAVI in the presence of concomitant MAC or MS at our center. Subgroups were built and multivariate logistic regression, COX regression, Kaplan-Meier survival analyses, and receiver operating characteristics method were performed.RESULTS: Thirty-day mortality was 7.5% (79/1,058) with highest mortality in patients severe MS (MAC: 3.4% vs. mild MS: 5.9% vs. moderate MS: 15.0% vs. severe MS: 72.7%; p < 0.001). Moderate-to-severe MS (odds ratio [OR]: 7.75, confidence interval [CI]: 3.94-16.26, p < 0.001), impaired left ventricular ejection fraction (OR: 1.38, CI: 1.10-1.72, p < 0.01), and coronary artery disease (OR: 1.36, CI: 1.11-1.67, p < 0.01) were predictive of 30-day survival. Left ventricular systolic/end-diastolic pressure drop of <59.5 mm Hg / <19.5 mm Hg was associated with increased mortality.CONCLUSIONS: TAVI in the presence of MAC and mild MS is associated with acceptable acute outcomes but should be considered high-risk procedures in patients with moderate and especially those with severe MS. Our results suggest adverse hemodynamics after TAVI with concomitant MS, which may be caused by underfilling of the left ventricle leading to low-cardiac output.
UR - https://www.ncbi.nlm.nih.gov/pubmed/32114689
U2 - 10.1055/s-0039-1700966
DO - 10.1055/s-0039-1700966
M3 - SCORING: Journal article
C2 - 32114689
VL - 69
SP - 428
EP - 436
JO - THORAC CARDIOV SURG
JF - THORAC CARDIOV SURG
SN - 0171-6425
IS - 5
ER -
