TY - JOUR

T1 - Transcatheter Treatment of Residual Significant Mitral Regurgitation Following TAVR

T2 - A Multicenter Registry

AU - Witberg, Guy

AU - Codner, Pablo

AU - Landes, Uri

AU - Brabanti, Marco

AU - Valvo, Roberto

AU - De Backer, Ole

AU - Ooms, Joris F.

AU - Sievert, Kolja

AU - El Sabbagh, Abdallah

AU - Jimenez-Quevedo, Pilar

AU - Brennan, Paul F.

AU - Sedaghat, Alexander

AU - Masiero, Giulia

AU - Werner, Paul

AU - Overtchouk, Pavel

AU - Watanabe, Yusuke

AU - Montorfano, Matteo

AU - Bijjam, Venu Reddy

AU - Hein, Manuel

AU - Fiorina, Claudia

AU - Arzamendi, Dabit

AU - Rodriguez-Gabella, Tania

AU - Fernández-Vázquez, Felipe

AU - Baz, Jose A.

AU - Laperche, Clemence

AU - Grasso, Carmelo

AU - Branca, Luca

AU - Estévez-Loureiro, Rodrigo

AU - Benito-González, Tomás

AU - Amat Santos, Ignacio J.

AU - Ruile, Philipp

AU - Mylotte, Darren

AU - Buzzatti, Nicola

AU - Piazza, Nicolo

AU - Andreas, Martin

AU - Tarantini, Giuseppe

AU - Sinning, Jan Malte

AU - Spence, Mark S.

AU - Nombela-Franco, Luis

AU - Guerrero, Mayra

AU - Sievert, Horst

AU - Sondergaard, Lars

AU - Van Mieghem, Nicolas M.

AU - Tchetche, Didier

AU - Webb, John G.

AU - Kornowski, Ran

PY - 2020

Y1 - 2020

N2 - Objectives: The aim of this study was to describe baseline characteristics, and periprocedural and mid-term outcomes of patients undergoing transcatheter mitral valve interventions post-transcatheter aortic valve replacement (TAVR) and examine their clinical benefit. Background: The optimal management of residual mitral regurgitation (MR) post-TAVR is challenging. Methods: This was an international registry of 23 TAVR centers. Results: In total, 106 of 24,178 patients (0.43%) underwent mitral interventions post-TAVR (100 staged, 6 concomitant), most commonly percutaneous edge-to-edge mitral valve repair (PMVR). The median interval post-TAVR was 164 days. Mean age was 79.5 ± 7.2 years, MR was >moderate in 97.2%, technical success was 99.1%, and 30-day device success rate was 88.7%. There were 18 periprocedural complications (16.9%) including 4 deaths. During a median follow-up of 464 days, the cumulative risk for 3-year mortality was 29.0%. MR grade and New York Heart Association (NYHA) functional class improved dramatically; at 1 year, MR was moderate or less in 90.9% of patients (mild or less in 69.1%), and 85.9% of patients were in NYHA functional class I/II. Staged PMVR was associated with lower mortality versus medical treatment (57.5% vs. 30.8%) in a propensity-matched cohort (n = 156), but this was not statistically significant (hazard ratio: 1.75; p = 0.05). Conclusions: For patients who continue to have significant MR, remain symptomatic post-TAVR, and are anatomically suitable for transcatheter interventions, these interventions are feasible, safe, and associated with significant improvement in MR grade and NYHA functional class. These results apply mainly to PMVR. A staged PMVR strategy was associated with markedly lower mortality, but this was not statistically significant. (Transcatheter Treatment for Combined Aortic and Mitral Valve Disease. The Aortic+Mitral TRAnsCatheter Valve Registry [AMTRAC]; NCT04031274)

AB - Objectives: The aim of this study was to describe baseline characteristics, and periprocedural and mid-term outcomes of patients undergoing transcatheter mitral valve interventions post-transcatheter aortic valve replacement (TAVR) and examine their clinical benefit. Background: The optimal management of residual mitral regurgitation (MR) post-TAVR is challenging. Methods: This was an international registry of 23 TAVR centers. Results: In total, 106 of 24,178 patients (0.43%) underwent mitral interventions post-TAVR (100 staged, 6 concomitant), most commonly percutaneous edge-to-edge mitral valve repair (PMVR). The median interval post-TAVR was 164 days. Mean age was 79.5 ± 7.2 years, MR was >moderate in 97.2%, technical success was 99.1%, and 30-day device success rate was 88.7%. There were 18 periprocedural complications (16.9%) including 4 deaths. During a median follow-up of 464 days, the cumulative risk for 3-year mortality was 29.0%. MR grade and New York Heart Association (NYHA) functional class improved dramatically; at 1 year, MR was moderate or less in 90.9% of patients (mild or less in 69.1%), and 85.9% of patients were in NYHA functional class I/II. Staged PMVR was associated with lower mortality versus medical treatment (57.5% vs. 30.8%) in a propensity-matched cohort (n = 156), but this was not statistically significant (hazard ratio: 1.75; p = 0.05). Conclusions: For patients who continue to have significant MR, remain symptomatic post-TAVR, and are anatomically suitable for transcatheter interventions, these interventions are feasible, safe, and associated with significant improvement in MR grade and NYHA functional class. These results apply mainly to PMVR. A staged PMVR strategy was associated with markedly lower mortality, but this was not statistically significant. (Transcatheter Treatment for Combined Aortic and Mitral Valve Disease. The Aortic+Mitral TRAnsCatheter Valve Registry [AMTRAC]; NCT04031274)

KW - aortic stenosis

KW - mitral regurgitation

KW - TAVR

KW - TMVR/r

U2 - 10.1016/j.jcin.2020.07.014

DO - 10.1016/j.jcin.2020.07.014

M3 - Journal article

C2 - 33303117

AN - SCOPUS:85097433454

VL - 13

SP - 2782

EP - 2791

JO - J A C C: Cardiovascular Interventions

JF - J A C C: Cardiovascular Interventions

SN - 1936-8798

IS - 23

ER -