Transcatheter Treatment of Residual Significant Mitral Regurgitation Following TAVR: A Multicenter Registry
Guy Witberg, Pablo Codner, Uri Landes, Marco Barbanti, Roberto Valvo, Ole De Backer, Joris F Ooms, Kolja Sievert, Abdallah El Sabbagh, Pilar Jimenez-Quevedo, Paul F Brennan, Alexander Sedaghat, Giulia Masiero, Paul Werner, Pavel Overtchouk, Yusuke Watanabe, Matteo Montorfano, Venu Reddy Bijjam, Manuel Hein, Claudia Fiorina, Dabit Arzamendi, Tania Rodriguez-Gabella, Felipe Fernández-Vázquez, Jose A Baz, Clemence Laperche, Carmelo Grasso, Luca Branca, Rodrigo Estévez-Loureiro, Tomás Benito-González, Ignacio J Amat Santos, Philipp Ruile, Darren Mylotte, Nicola Buzzatti, Nicolo Piazza, Martin Andreas, Giuseppe Tarantini, Jan-Malte Sinning, Mark S Spence, Luis Nombela-Franco, Mayra Guerrero, Horst Sievert, Lars Sondergaard, Nicolas M Van Mieghem, Didier Tchetche, John G Webb, Ran Kornowski, Guy Witberg, Pablo Codner, Uri Landes, Marco Barbanti, Roberto Valvo, Ole De Backer, Joris F Ooms, Kolja Sievert, Abdallah El Sabbagh, Pilar Jimenez-Quevedo, Paul F Brennan, Alexander Sedaghat, Giulia Masiero, Paul Werner, Pavel Overtchouk, Yusuke Watanabe, Matteo Montorfano, Venu Reddy Bijjam, Manuel Hein, Claudia Fiorina, Dabit Arzamendi, Tania Rodriguez-Gabella, Felipe Fernández-Vázquez, Jose A Baz, Clemence Laperche, Carmelo Grasso, Luca Branca, Rodrigo Estévez-Loureiro, Tomás Benito-González, Ignacio J Amat Santos, Philipp Ruile, Darren Mylotte, Nicola Buzzatti, Nicolo Piazza, Martin Andreas, Giuseppe Tarantini, Jan-Malte Sinning, Mark S Spence, Luis Nombela-Franco, Mayra Guerrero, Horst Sievert, Lars Sondergaard, Nicolas M Van Mieghem, Didier Tchetche, John G Webb, Ran Kornowski
Abstract
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).
Keywords: TAVR; TMVR/r; aortic stenosis; mitral regurgitation.
Conflict of interest statement
Author Disclosures Dr. Barbanti has received consultant fees from Edwards Lifesciences. Dr. De Backer has received research grants and consultant fees from Abbott and Boston Scientific. Dr. Sievert has received institutional honoraria, travel expenses, and consulting fees from 4tech Cardio, Abbott, Ablative Solutions, Ancora Heart, Append Medical, Bavaria Medizin Technologie GmbH, Bioventrix, Boston Scientific, Carag, CardiacDimensions, Cardimed, Celonova, Comed B.V., Contego, CVRx, Dinova, Edwards Lifesciences, Endologix, Hemoteq, Hangzhou Nuomao Medtech, Holistick Medical, Lifetech, Maquet Getinge Group, Medtronic, Mokita, Occlutech, Recor, RenalGuard, Terumo, Vascular Dynamics, Vectorious Medtech, Venus, Venock, and Vivasure Medical. Dr. Grasso has been a proctor for Abbott Vascular. Dr. Andreas has been a proctor for Abbott and Edwards Lifesciences; and has received advisory board fees from Medtronic. Dr. Guerrero has received research grant support from Edwards Lifesciences. Dr. Van Mieghem has received research grant support from Abbott, Boston Scientific, Edwards Lifesciences, Medtronic, PulseCath BV, and Daiichi-Sankyo; and 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.
Copyright © 2020 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
Source: PubMed