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. Adams; Michael J. Reardon

doi:10.1016/j.jtcvs.2017.11.108

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 journal › Article › peer-review

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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 language	English (US)
Pages (from-to)	1991-1999
Number of pages	9
Journal	Journal of Thoracic and Cardiovascular Surgery
Volume	155
Issue number	5
DOIs	https://doi.org/10.1016/j.jtcvs.2017.11.108
State	Accepted/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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10.1016/j.jtcvs.2017.11.108

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Little, S. H., Popma, J. J., Kleiman, N. S., Deeb, G. M., Gleason, T. G., Yakubov, S. J., Checuti, S., O'Hair, D., Bajwa, T., Mumtaz, M., Maini, B., Hartman, A., Katz, S., Robinson, N., Petrossian, G., Heiser, J., Merhi, W., Moore, B. J., Li, S., ... Reardon, M. J. (Accepted/In press). Transcatheter aortic valve replacement in patients with severe mitral or tricuspid regurgitation at extreme risk for surgery. Journal of Thoracic and Cardiovascular Surgery, 155(5), 1991-1999. https://doi.org/10.1016/j.jtcvs.2017.11.108

Little, SH, Popma, JJ, Kleiman, NS, Deeb, GM, Gleason, TG, Yakubov, SJ, Checuti, S, O'Hair, D, Bajwa, T, Mumtaz, M, Maini, B, Hartman, A, Katz, S, Robinson, N, Petrossian, G, Heiser, J, Merhi, W, Moore, BJ, Li, S, Adams, DH & Reardon, MJ 2018, 'Transcatheter aortic valve replacement in patients with severe mitral or tricuspid regurgitation at extreme risk for surgery', Journal of Thoracic and Cardiovascular Surgery, vol. 155, no. 5, pp. 1991-1999. https://doi.org/10.1016/j.jtcvs.2017.11.108

@article{e966342b01e84270bca3f595f71b38c8,

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

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.",

keywords = "Aortic stenosis, Mitral valve regurgitation, Transcatheter aortic valve replacement, Tricuspid valve regurgitation",

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

note = "Publisher Copyright: {\textcopyright} 2018 The American Association for Thoracic Surgery",

year = "2018",

doi = "10.1016/j.jtcvs.2017.11.108",

language = "English (US)",

volume = "155",

pages = "1991--1999",

journal = "Journal of Thoracic and Cardiovascular Surgery",

issn = "0022-5223",

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T1 - Transcatheter aortic valve replacement in patients with severe mitral or tricuspid regurgitation at extreme risk for surgery

AU - Little, Stephen H.

AU - Popma, Jeffrey J.

AU - Kleiman, Neal S.

AU - Deeb, G. Michael

AU - Gleason, Thomas G.

AU - Yakubov, Steven J.

AU - Checuti, Stan

AU - O'Hair, Daniel

AU - Bajwa, Tanvir

AU - Mumtaz, Mubashir

AU - Maini, Brijeshwar

AU - Hartman, Alan

AU - Katz, Stanley

AU - Robinson, Newell

AU - Petrossian, George

AU - Heiser, John

AU - Merhi, William

AU - Moore, B. Jane

AU - Li, Shuzhen

AU - Adams, David H.

AU - Reardon, Michael J.

PY - 2018

Y1 - 2018

N2 - 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.

AB - 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.

KW - Aortic stenosis

KW - Mitral valve regurgitation

KW - Transcatheter aortic valve replacement

KW - Tricuspid valve regurgitation

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

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