Transcatheter aortic valve replacement in patients with severe mitral or tricuspid regurgitation at extreme risk for surgery

Stephen H. Little, Jeffrey J. Popma, Neal S. Kleiman, G. Michael Deeb, Thomas G. Gleason, Steven J. Yakubov, Stan Checuti, Daniel O'Hair, Tanvir Bajwa, Mubashir Mumtaz, Brijeshwar Maini, Alan Hartman, Stanley Katz, Newell Robinson, George Petrossian, John Heiser, William Merhi, B. Jane Moore, Shuzhen Li, David H. AdamsMichael J. Reardon

Research output: Contribution to journalArticle

5 Scopus citations

Abstract

Objectives: Patients with symptomatic severe aortic stenosis and severe mitral regurgitation or severe tricuspid regurgitation were excluded from the major transcatheter aortic valve replacement trials. We studied these 2 subgroups in patients at extreme risk for surgery in the prospective, nonrandomized, single-arm CoreValve US Expanded Use Study. Methods: The primary end point was all-cause mortality or major stroke at 1 year. A favorable medical benefit was defined as a Kansas City Cardiomyopathy Questionnaire overall summary score greater than 45 at 6 months and greater than 60 at 1 year and with a less than 10-point decrease from baseline. Results: There were 53 patients in each group. Baseline characteristics for the severe mitral regurgitation and severe tricuspid regurgitation cohorts were age 84.2 ± 6.4 years and 84.9 ± 6.5 years; male, 29 (54.7%) and 22 (41.5%), and mean Society of Thoracic Surgeons score 9.9% ± 5.0% and 9.2% ± 4.0%, respectively. Improvement in valve regurgitation from baseline to 1 year occurred in 72.7% of the patients with severe mitral regurgitation and in 61.8% of patients with severe tricuspid regurgitation. A favorable medical benefit occurred in 31 of 47 patients (66.0%) with severe mitral regurgitation and 33 of 47 patients (70.2%) with severe tricuspid regurgitation at 6 months, and in 25 of 44 patients (56.8%) with severe mitral regurgitation and 24 of 45 patients (53.3%) with severe tricuspid regurgitation at 1 year. All-cause mortality or major stroke for the severe mitral regurgitation and severe tricuspid regurgitation cohorts were 11.3% and 3.8% at 30 days and 21.0% and 19.2% at 1 year, respectively. There were no major strokes in either group at 1 year. Conclusions: Transcatheter aortic valve replacement in patients with severe mitral regurgitation or severe tricuspid regurgitation is reasonable and safe and leads to improvement in atrioventricular valve regurgitation.

Original languageEnglish (US)
Pages (from-to)1991-1999
Number of pages9
JournalJournal of Thoracic and Cardiovascular Surgery
Volume155
Issue number5
DOIs
StateAccepted/In press - 2018

Keywords

  • Aortic stenosis
  • Mitral valve regurgitation
  • Transcatheter aortic valve replacement
  • Tricuspid valve regurgitation

ASJC Scopus subject areas

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

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