Effect of Transcatheter Aortic Valve Replacement on Concomitant Mitral Regurgitation and Its Impact on Mortality
Publikation: Bidrag til tidsskrift › Tidsskriftartikel › Forskning › fagfællebedømt
Standard
Effect of Transcatheter Aortic Valve Replacement on Concomitant Mitral Regurgitation and Its Impact on Mortality. / Witberg, Guy; Codner, Pablo; Landes, Uri; Schwartzenberg, Shmuel; Barbanti, Marco; Valvo, Roberto; De Backer, Ole; Ooms, Joris F.; Islas, Fabian; Marroquin, Luis; Sedaghat, Alexander; Sugiura, Atsushi; Masiero, Giulia; Werner, Paul; Armario, Xavier; Fiorina, Claudia; Arzamendi, Dabit; Santos-Martinez, Sandra; Fernández-Vázquez, Felipe; Baz, Jose A.; Steblovnik, Klemen; Mauri, Victor; Adam, Matti; Merdler, Ilan; Hein, Manuel; Ruile, Philipp; Grasso, Carmelo; Branca, Luca; Estévez-Loureiro, Rodrigo; Benito-González, Tomás; Amat-Santos, Ignacio J.; Mylotte, Darren; Andreas, Martin; Bunc, Matjaz; Tarantini, Giuseppe; Sinning, Jan Malte; Nombela-Franco, Luis; Søndergaard, Lars; Van Mieghem, Nicolas M.; Finkelstein, Ariel; Kornowski, Ran.
I: JACC: Cardiovascular Interventions, Bind 14, Nr. 11, 2021, s. 1181-1192.Publikation: Bidrag til tidsskrift › Tidsskriftartikel › Forskning › fagfællebedømt
Harvard
APA
Vancouver
Author
Bibtex
}
RIS
TY - JOUR
T1 - Effect of Transcatheter Aortic Valve Replacement on Concomitant Mitral Regurgitation and Its Impact on Mortality
AU - Witberg, Guy
AU - Codner, Pablo
AU - Landes, Uri
AU - Schwartzenberg, Shmuel
AU - Barbanti, Marco
AU - Valvo, Roberto
AU - De Backer, Ole
AU - Ooms, Joris F.
AU - Islas, Fabian
AU - Marroquin, Luis
AU - Sedaghat, Alexander
AU - Sugiura, Atsushi
AU - Masiero, Giulia
AU - Werner, Paul
AU - Armario, Xavier
AU - Fiorina, Claudia
AU - Arzamendi, Dabit
AU - Santos-Martinez, Sandra
AU - Fernández-Vázquez, Felipe
AU - Baz, Jose A.
AU - Steblovnik, Klemen
AU - Mauri, Victor
AU - Adam, Matti
AU - Merdler, Ilan
AU - Hein, Manuel
AU - Ruile, Philipp
AU - Grasso, Carmelo
AU - Branca, Luca
AU - Estévez-Loureiro, Rodrigo
AU - Benito-González, Tomás
AU - Amat-Santos, Ignacio J.
AU - Mylotte, Darren
AU - Andreas, Martin
AU - Bunc, Matjaz
AU - Tarantini, Giuseppe
AU - Sinning, Jan Malte
AU - Nombela-Franco, Luis
AU - Søndergaard, Lars
AU - Van Mieghem, Nicolas M.
AU - Finkelstein, Ariel
AU - Kornowski, Ran
N1 - Funding Information: Dr. Barbanti has received consultant fees from Edwards Lifesciences. Dr. Grasso has served as a proctor for Abbott Vascular. Dr. De Backer has received research grants and consultant fees from Abbott and Boston Scientific. Dr. Andreas has served as a proctor for Abbott and Edwards Lifesciences; and has received advisory board fees from Medtronic. Dr. Estévez-Loureiro has served as a consultant for Abbott Vascular and Boston Scientific. Dr. Amat-Santos has served as a proctor for Boston Scientific. Dr. Nombela-Franco has received consultant fees from Edwards Lifesciences; and has served as a proctor for Abbott. Dr. Søndergaard has received consultant fees and institutional research from Abbott, Boston Scientific, Edwards Lifesciences, and Medtronic. Dr. Van Mieghem has received research grant support from Abbott, Boston Scientific, Edwards Lifesciences, Medtronic, PulseCath BV, and Daiichi-Sankyo; and has received advisory fees from Abbott, Boston Scientific, Ancora, Medtronic, PulseCath BV, and Daiichi-Sankyo. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. Publisher Copyright: © 2021 American College of Cardiology Foundation
PY - 2021
Y1 - 2021
N2 - Objectives: The purpose of this study was to examine the impact of residual mitral regurgitation (MR) on mortality in patients undergoing transcatheter aortic valve replacement (TAVR). Background: MR is common in patients undergoing TAVR. Data on optimal management of patients with significant MR after TAVR are limited. Methods: The registry consisted of 16 TAVR centers (n = 7,303). Outcomes of patients with ≥ moderate versus lesser grade MR after TAVR were compared. Results: In 1,983 (27.2%) patients, baseline MR grade was ≥ moderate. MR regressed in 874 (44.1%) patients and persisted in 1,109 (55.9%) after TAVR. Four-year mortality was higher for those with MR persistence, but not for those with MR regression after TAVR, compared with nonsignificant baseline MR (43.8% vs. 35.1% vs. 32.4%; hazard ratio [HR]: 1.38; p = 0.008; HR: 1.02; p = 0.383, respectively). New York Heart Association functional class III to IV after TAVR was more common in those with MR persistence vs. regression (14.4% vs. 3.9%; p < 0.001). In a propensity score–matched cohort (91 patients’ pairs), with significant residual MR after TAVR who did or did not undergo staged mitral intervention, staged intervention was associated with a better functional class through 1 year of follow-up (82.4% vs. 33.3% New York Heart Association functional class I or II; p < 0.001), and a numerically lower 4-year mortality, which was not statistically significant (64.6% vs. 37.5%; HR: 1.66; p = 0.097). Conclusions: Risk stratification based on improvement in MR and symptoms after TAVR can identify patients at increased mortality risk after TAVR. These patients may benefit from a staged transcatheter mitral intervention, but this requires further proof from future studies. (Transcatheter Treatment for Combined Aortic and Mitral Valve Disease. The Aortic+Mitral TRAnsCatheter [AMTRAC] Valve Registry [AMTRAC]; NCT04031274).
AB - Objectives: The purpose of this study was to examine the impact of residual mitral regurgitation (MR) on mortality in patients undergoing transcatheter aortic valve replacement (TAVR). Background: MR is common in patients undergoing TAVR. Data on optimal management of patients with significant MR after TAVR are limited. Methods: The registry consisted of 16 TAVR centers (n = 7,303). Outcomes of patients with ≥ moderate versus lesser grade MR after TAVR were compared. Results: In 1,983 (27.2%) patients, baseline MR grade was ≥ moderate. MR regressed in 874 (44.1%) patients and persisted in 1,109 (55.9%) after TAVR. Four-year mortality was higher for those with MR persistence, but not for those with MR regression after TAVR, compared with nonsignificant baseline MR (43.8% vs. 35.1% vs. 32.4%; hazard ratio [HR]: 1.38; p = 0.008; HR: 1.02; p = 0.383, respectively). New York Heart Association functional class III to IV after TAVR was more common in those with MR persistence vs. regression (14.4% vs. 3.9%; p < 0.001). In a propensity score–matched cohort (91 patients’ pairs), with significant residual MR after TAVR who did or did not undergo staged mitral intervention, staged intervention was associated with a better functional class through 1 year of follow-up (82.4% vs. 33.3% New York Heart Association functional class I or II; p < 0.001), and a numerically lower 4-year mortality, which was not statistically significant (64.6% vs. 37.5%; HR: 1.66; p = 0.097). Conclusions: Risk stratification based on improvement in MR and symptoms after TAVR can identify patients at increased mortality risk after TAVR. These patients may benefit from a staged transcatheter mitral intervention, but this requires further proof from future studies. (Transcatheter Treatment for Combined Aortic and Mitral Valve Disease. The Aortic+Mitral TRAnsCatheter [AMTRAC] Valve Registry [AMTRAC]; NCT04031274).
KW - aortic stenosis
KW - mitral regurgitation
KW - TAVR
KW - TMVR/r
U2 - 10.1016/j.jcin.2021.02.030
DO - 10.1016/j.jcin.2021.02.030
M3 - Journal article
C2 - 33992550
AN - SCOPUS:85106907405
VL - 14
SP - 1181
EP - 1192
JO - J A C C: Cardiovascular Interventions
JF - J A C C: Cardiovascular Interventions
SN - 1936-8798
IS - 11
ER -
ID: 301720090