Transcatheter Aortic Valve Replacement After Prior Mitral Valve Surgery: Results From the Transcatheter Valve Therapy Registry

Vinod H. Thourani, John J. Kelly, David G. Cervantes, Sreekanth Vemulapalli, Pratik Manandhar, Jessica Forcillo, David R. Holmes, David J. Cohen, Ajay J. Kirtane, Susheel K. Kodali, Martin B. Leon, Vasilis Babaliaros, Ron Waksman, Lowell F. Satler, Christian C. Shults, Itsik Ben-Dor, Toby Rogers, Samir Kapadia, Micheal J. Reardon, S. Chris MalaisrieThomas G. Gleason, Elizabeth M. Holper, Joseph E. Bavaria, Howard C. Herrmann, Wilson Y. Szeto, John D. Carroll, Michael J. Mack

Research output: Contribution to journalArticle

Abstract

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.

Original languageEnglish (US)
Pages (from-to)1789-1796
Number of pages8
JournalAnnals of Thoracic Surgery
Volume109
Issue number6
DOIs
StatePublished - Jun 2020

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

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