TY - JOUR
T1 - Transcatheter Aortic Valve Replacement After Prior Mitral Valve Surgery
T2 - Results From the Transcatheter Valve Therapy Registry
AU - Thourani, Vinod H.
AU - Kelly, John J.
AU - Cervantes, David G.
AU - Vemulapalli, Sreekanth
AU - Manandhar, Pratik
AU - Forcillo, Jessica
AU - Holmes, David R.
AU - Cohen, David J.
AU - Kirtane, Ajay J.
AU - Kodali, Susheel K.
AU - Leon, Martin B.
AU - Babaliaros, Vasilis
AU - Waksman, Ron
AU - Satler, Lowell F.
AU - Shults, Christian C.
AU - Ben-Dor, Itsik
AU - Rogers, Toby
AU - Kapadia, Samir
AU - Reardon, Micheal J.
AU - Malaisrie, S. Chris
AU - Gleason, Thomas G.
AU - Holper, Elizabeth M.
AU - Bavaria, Joseph E.
AU - Herrmann, Howard C.
AU - Szeto, Wilson Y.
AU - Carroll, John D.
AU - Mack, Michael J.
N1 - Publisher Copyright:
© 2020 The Society of Thoracic Surgeons
PY - 2020/6
Y1 - 2020/6
N2 - Background: Due to perceived technical challenges, patients with previous surgical mitral valve repair or replacement (SMVR) have been excluded from most transcatheter aortic valve replacement (TAVR) trials. Our objective was to compare the 30-day and 1-year outcomes of TAVR for patients with and without prior SMVR. Methods: In a retrospective review of The Society of Thoracic Surgeons (STS) and American College of Cardiology (ACC) Transcatheter Valve Therapy (TVT) Registry, we compared 1097 patients with prior SMVR to 46,327 patients without prior SMVR who underwent TAVR between November 2011 and September 2015 at 394 US centers. Preoperative characteristics, procedural details, and clinical outcomes were analyzed. Results: Patients with previous SMVR were younger, more often female, and had higher STS predicted risk of mortality (8.6% vs 6.8%, P < .001). However, there was no difference in 30-day mortality (4.6% vs 5.5%, P = .293), myocardial infarction, stroke, reintervention, new dialysis, or readmission. Moderate/severe paravalvular leak at discharge was also similar (5.8% vs 4.9%, P = .343). At 1 year, morbidity was similar with slightly higher mortality among patients with prior SMVR (20% vs 17.5%, P = .087) that was significant after adjustment (hazard ratio 1.18, P = .043). The type of prior SMVR (repair, bioprosthetic replacement, or mechanical replacement) had no impact on 30-day or 1-year survival. Conclusions: Patients with prior SMVR undergoing TAVR had similar 30-day outcomes, slightly higher 1-year mortality, and no increase in early paravalvular leak compared with patients who did not have previous SMVR. Prior SMVR should not preclude TAVR for appropriately selected patients.
AB - Background: Due to perceived technical challenges, patients with previous surgical mitral valve repair or replacement (SMVR) have been excluded from most transcatheter aortic valve replacement (TAVR) trials. Our objective was to compare the 30-day and 1-year outcomes of TAVR for patients with and without prior SMVR. Methods: In a retrospective review of The Society of Thoracic Surgeons (STS) and American College of Cardiology (ACC) Transcatheter Valve Therapy (TVT) Registry, we compared 1097 patients with prior SMVR to 46,327 patients without prior SMVR who underwent TAVR between November 2011 and September 2015 at 394 US centers. Preoperative characteristics, procedural details, and clinical outcomes were analyzed. Results: Patients with previous SMVR were younger, more often female, and had higher STS predicted risk of mortality (8.6% vs 6.8%, P < .001). However, there was no difference in 30-day mortality (4.6% vs 5.5%, P = .293), myocardial infarction, stroke, reintervention, new dialysis, or readmission. Moderate/severe paravalvular leak at discharge was also similar (5.8% vs 4.9%, P = .343). At 1 year, morbidity was similar with slightly higher mortality among patients with prior SMVR (20% vs 17.5%, P = .087) that was significant after adjustment (hazard ratio 1.18, P = .043). The type of prior SMVR (repair, bioprosthetic replacement, or mechanical replacement) had no impact on 30-day or 1-year survival. Conclusions: Patients with prior SMVR undergoing TAVR had similar 30-day outcomes, slightly higher 1-year mortality, and no increase in early paravalvular leak compared with patients who did not have previous SMVR. Prior SMVR should not preclude TAVR for appropriately selected patients.
UR - http://www.scopus.com/inward/record.url?scp=85084834110&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85084834110&partnerID=8YFLogxK
U2 - 10.1016/j.athoracsur.2019.08.113
DO - 10.1016/j.athoracsur.2019.08.113
M3 - Article
C2 - 31655043
AN - SCOPUS:85084834110
VL - 109
SP - 1789
EP - 1796
JO - Annals of Thoracic Surgery
JF - Annals of Thoracic Surgery
SN - 0003-4975
IS - 6
ER -