Lee Joseph1, Mohammad Bashir2, Qun Xiang3, Babatunde A Yerokun3, Roland Albert Matsouaka4, Sreekanth Vemulapalli3, Samir Kapadia5, Joaquin E Cigarroa6, Firas Zahr7. 1. Division of Cardiovascular Diseases, Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa. 2. Division of Cardiothoracic Surgery, Department of Surgery, University of Iowa Carver College of Medicine, Iowa City, Iowa. 3. Duke Clinical Research Institute, Durham, North Carolina. 4. Duke Clinical Research Institute, Durham, North Carolina; Department of Biostatistics and Bioinformatics, Duke University, Durham, North Carolina. 5. Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio. 6. Knight Cardiovascular Institute, Oregon Health & Sciences University, Portland, Oregon. 7. Knight Cardiovascular Institute, Oregon Health & Sciences University, Portland, Oregon. Electronic address: zahr@ohsu.edu.
Abstract
OBJECTIVES: This study sought to examine the prevalence of mitral stenosis (MS) and its impact on in-hospital and 1-year clinical outcomes among patients undergoing transcatheter aortic valve replacement (TAVR). BACKGROUND: Patients with coexisting severe aortic stenosis and MS are increasingly being considered for TAVR. METHODS: The study cohort included 44,755 patients (age ≥18 years) who underwent TAVR during November 1, 2011, to September 30, 2015, and were registered in Society of Thoracic Surgeons/American College of Cardiology Transcatheter Valve Therapies (TVT) Registry. One-year outcomes were assessed by linking TVT registry data of this cohort to patient-specific Centers for Medicare & Medicaid Services administrative claims data (n = 31,453). The primary outcome was the composite of death, stroke, heart failure-related hospitalization, and mitral valve intervention at 1 year. RESULTS: MS was present in 11.6% of cohort (mean age, 82 years; 52% males), being severe in 2.7%. Severe MS was associated with higher in-hospital mortality rates (5.6% vs. 3.9% for nonsevere MS and 4.1% for no MS; p = 0.02). In contrast to those without MS, severe MS group had significantly higher risk for the primary outcome, mortality (1 year), and heart failure-related hospitalization (1 year) (adjusted hazard ratio: 1.2 [95% confidence interval (CI): 1.1 to 1.4], 1.2 [95% CI: 1.0 to 1.4], and 1.3 [95% CI: 1.1 to 1.5], respectively; p < 0.05 for all). CONCLUSIONS: Approximately one-tenth of patients undergoing TAVR have concomitant MS. Severe MS is an independent predictor of 1-year adverse clinical outcomes following TAVR. The higher risk for long-term adverse events must be considered when evaluating patients with combined aortic stenosis and MS for TAVR.
OBJECTIVES: This study sought to examine the prevalence of mitral stenosis (MS) and its impact on in-hospital and 1-year clinical outcomes among patients undergoing transcatheter aortic valve replacement (TAVR). BACKGROUND:Patients with coexisting severe aortic stenosis and MS are increasingly being considered for TAVR. METHODS: The study cohort included 44,755 patients (age ≥18 years) who underwent TAVR during November 1, 2011, to September 30, 2015, and were registered in Society of Thoracic Surgeons/American College of Cardiology Transcatheter Valve Therapies (TVT) Registry. One-year outcomes were assessed by linking TVT registry data of this cohort to patient-specific Centers for Medicare & Medicaid Services administrative claims data (n = 31,453). The primary outcome was the composite of death, stroke, heart failure-related hospitalization, and mitral valve intervention at 1 year. RESULTS: MS was present in 11.6% of cohort (mean age, 82 years; 52% males), being severe in 2.7%. Severe MS was associated with higher in-hospital mortality rates (5.6% vs. 3.9% for nonsevere MS and 4.1% for no MS; p = 0.02). In contrast to those without MS, severe MS group had significantly higher risk for the primary outcome, mortality (1 year), and heart failure-related hospitalization (1 year) (adjusted hazard ratio: 1.2 [95% confidence interval (CI): 1.1 to 1.4], 1.2 [95% CI: 1.0 to 1.4], and 1.3 [95% CI: 1.1 to 1.5], respectively; p < 0.05 for all). CONCLUSIONS: Approximately one-tenth of patients undergoing TAVR have concomitant MS. Severe MS is an independent predictor of 1-year adverse clinical outcomes following TAVR. The higher risk for long-term adverse events must be considered when evaluating patients with combined aortic stenosis and MS for TAVR.
Authors: Gregory Pappas; Jesse Berlin; Erika Avila-Tang; John Carroll; Joseph Drozda; Douglas Dumont; Thomas Gross; Kathleen Hewitt; Ajay Kirtane; David Kong; Mitchell Krucoff; John Lashinger; Nellie Lew; Michael Mack; Fred Masoudi; Danica Marinac-Dabic; Roxanna Mehran; Sharon-Lise Normand; Elizabeth Quin; Fred Resnic; Art Sedrakyan; Ronald Waksman; Larry Wood; Changfu Wu; Tianay Ziegler Journal: BMJ Surg Interv Health Technol Date: 2019-07-04