Ignacio J Amat-Santos1, Carlos Cortés2, Luis Nombela Franco3, Antonio J Muñoz-García4, Jose Suárez De Lezo5, Enrique Gutiérrez-Ibañes6, Vicenç Serra7, Mariano Larman8, Raúl Moreno9, Jose M De La Torre Hernandez10, Rishi Puri11, Pilar Jimenez-Quevedo3, José M Hernández García4, Juan H Alonso-Briales4, Bruno García7, Dae-Hyun Lee10, Paol Rojas2, Teresa Sevilla12, Renier Goncalves12, Silvio Vera2, Itziar Gómez12, Josep Rodés-Cabau13, José A San Román12. 1. CIBERCV, Hospital Clínico Universitario, Valladolid, Spain. Electronic address: ijamat@gmail.com. 2. Institute of Heart Sciences, Hospital Clínico Universitario, Valladolid, Spain. 3. Hospital Clínico Universitario San Carlos, Madrid, Spain. 4. CIBERCV, Hospital Clínico Universitario Virgen de la Victoria, Málaga, Spain. 5. Hospital Universitario Reina Sofía, Córdoba, Spain. 6. Hospital General Universitario Gregorio Marañon, Madrid, Spain. 7. Hospital Universitario Vall D'Hebron, Barcelona, Spain. 8. Hospital Universitario Donostia, San Sebastián, Spain. 9. Hospital Universitario La Paz, Madrid, Spain. 10. Hospital Universitario Marques de Valdecilla, Santander, Spain. 11. Institute Universitaire de Cardiologie et Pneumologie de Quebec, Ville de Québec, Québec, Canada; Department of Medicine, University of Adelaide, Australia; Cleveland Clinic Coordinating Center for Clinical Research, Cleveland, Ohio. 12. CIBERCV, Hospital Clínico Universitario, Valladolid, Spain. 13. Institute Universitaire de Cardiologie et Pneumologie de Quebec, Ville de Québec, Québec, Canada.
Abstract
OBJECTIVES: The aim of this study was to determine the prognosis and specific complications of patients with prosthetic mitral valves (PMVs) undergoing transcatheter aortic valve replacement (TAVR). BACKGROUND: TAVR is performed relatively often in patients with PMVs, but specific risks are not well described. METHODS: A multicenter analysis was conducted, including patients with severe symptomatic aortic stenosis who underwent TAVR at 10 centers. Patients' clinical characteristics and outcomes were evaluated according to the presence of a PMV. RESULTS: The mean age of the study population (n = 2,414) was 81 ± 8 years, and 48.8% were men. A total of 91 patients (3.77%) had PMVs. They were more commonly women, younger, and had higher surgical risk. PMVs were implanted a median of 14 years before TAVR, and most patients had mechanical prostheses (73.6%). Eighty-six patients (94.5%) were on long-term vitamin K inhibitor therapy, and bridging antithrombotic therapy was administered in 59 (64.8%). TAVR device embolization occurred in 6.7% (vs. 3.3% in the non-PMV group; p = 0.127), in all instances when distance between the PMV and the aortic annulus was <7 mm. Mortality rates did not show a difference, but the rate of bleeding was higher in patients with PMV (24.2% vs. 16.1%; p = 0.041), even in those treated via the transfemoral approach (22.2% vs. 13.9%; p = 0.048). Indeed, bleeding complications, prior atrial fibrillation, chronic obstructive pulmonary disease, surgical risk, and New York Heart Association functional class were independent predictors of mortality. CONCLUSIONS: TAVR presents similar mortality irrespective of the presence of a PMV. However, patients with PMVs had higher bleeding risk that was independently associated with higher mortality. Risk for valve embolization was relatively high, but it occurred only in patients with PMV-to-aortic annulus distances <7 mm.
OBJECTIVES: The aim of this study was to determine the prognosis and specific complications of patients with prosthetic mitral valves (PMVs) undergoing transcatheter aortic valve replacement (TAVR). BACKGROUND: TAVR is performed relatively often in patients with PMVs, but specific risks are not well described. METHODS: A multicenter analysis was conducted, including patients with severe symptomatic aortic stenosis who underwent TAVR at 10 centers. Patients' clinical characteristics and outcomes were evaluated according to the presence of a PMV. RESULTS: The mean age of the study population (n = 2,414) was 81 ± 8 years, and 48.8% were men. A total of 91 patients (3.77%) had PMVs. They were more commonly women, younger, and had higher surgical risk. PMVs were implanted a median of 14 years before TAVR, and most patients had mechanical prostheses (73.6%). Eighty-six patients (94.5%) were on long-term vitamin K inhibitor therapy, and bridging antithrombotic therapy was administered in 59 (64.8%). TAVR device embolization occurred in 6.7% (vs. 3.3% in the non-PMV group; p = 0.127), in all instances when distance between the PMV and the aortic annulus was <7 mm. Mortality rates did not show a difference, but the rate of bleeding was higher in patients with PMV (24.2% vs. 16.1%; p = 0.041), even in those treated via the transfemoral approach (22.2% vs. 13.9%; p = 0.048). Indeed, bleeding complications, prior atrial fibrillation, chronic obstructive pulmonary disease, surgical risk, and New York Heart Association functional class were independent predictors of mortality. CONCLUSIONS: TAVR presents similar mortality irrespective of the presence of a PMV. However, patients with PMVs had higher bleeding risk that was independently associated with higher mortality. Risk for valve embolization was relatively high, but it occurred only in patients with PMV-to-aortic annulus distances <7 mm.