| Literature DB >> 30357365 |
Sung-Han Yoon1, Brian K Whisenant2, Sabine Bleiziffer3, Victoria Delgado4, Abhijeet Dhoble5, Niklas Schofer6, Lena Eschenbach3, Eric Bansal7, Dale J Murdoch8, Marco Ancona9, Tobias Schmidt10, Ermela Yzeiraj11, Flavien Vincent12, Hiroki Niikura13, Won-Keun Kim14, Masahiko Asami15, Axel Unbehaun16, Sameer Hirji17, Buntaro Fujita18, Miriam Silaschi19, Gilbert H L Tang20, Shingo Kuwata21, S Chiu Wong22, Antonio H Frangieh23, Colin M Barker24, James E Davies25, Alexander Lauten26, Florian Deuschl6, Luis Nombela-Franco27, Rajiv Rampat28, Pedro Felipe Gomes Nicz29, Jean-Bernard Masson30, Harindra C Wijeysundera31, Horst Sievert32, Daniel J Blackman33, Enrique Gutierrez-Ibanes34, Daisuke Sugiyama35, Tarun Chakravarty1, David Hildick-Smith28, Fabio Sandoli de Brito36, Christoph Jensen37, Christian Jung38, Richard W Smalling5, Martin Arnold39, Simon Redwood40, Albert Markus Kasel23, Francesco Maisano21, Hendrik Treede19, Stephan M Ensminger18, Saibal Kar1, Tsuyoshi Kaneko17, Thomas Pilgrim15, Paul Sorajja13, Eric Van Belle12, Bernard D Prendergast40, Vinayak Bapat41, Thomas Modine12, Joachim Schofer11, Christian Frerker10, Joerg Kempfert16, Guilherme F Attizzani7, Azeem Latib9, Ulrich Schaefer6, John G Webb8, Jeroen J Bax4, Raj R Makkar1.
Abstract
Aims: We sought to evaluate the outcomes of transcatheter mitral valve replacement (TMVR) for patients with degenerated bioprostheses [valve-in-valve (ViV)], failed annuloplasty rings [valve-in-ring (ViR)], and severe mitral annular calcification [valve-in-mitral annular calcification (ViMAC)]. Methods and results: From the TMVR multicentre registry, procedural and clinical outcomes of ViV, ViR, and ViMAC were compared according to Mitral Valve Academic Research Consortium (MVARC) criteria. A total of 521 patients with mean Society of Thoracic Surgeons score of 9.0 ± 7.0% underwent TMVR (322 patients with ViV, 141 with ViR, and 58 with ViMAC). Trans-septal access and the Sapien valves were used in 39.5% and 90.0%, respectively. Overall technical success was excellent at 87.1%. However, left ventricular outflow tract obstruction occurred more frequently after ViMAC compared with ViR and ViV (39.7% vs. 5.0% vs. 2.2%; P < 0.001), whereas second valve implantation was more frequent in ViR compared with ViMAC and ViV (12.1% vs. 5.2% vs. 2.5%; P < 0.001). Accordingly, technical success rate was higher after ViV compared with ViR and ViMAC (94.4% vs. 80.9% vs. 62.1%; P < 0.001). Compared with ViMAC and ViV groups, ViR group had more frequent post-procedural mitral regurgitation ≥moderate (18.4% vs. 13.8% vs. 5.6%; P < 0.001) and subsequent paravalvular leak closure (7.8% vs. 0.0% vs. 2.2%; P = 0.006). All-cause mortality was higher after ViMAC compared with ViR and ViV at 30 days (34.5% vs. 9.9% vs. 6.2%; log-rank P < 0.001) and 1 year (62.8% vs. 30.6% vs. 14.0%; log-rank P < 0.001). On multivariable analysis, patients with failed annuloplasty rings and severe MAC were at increased risk of mortality after TMVR [ViR vs. ViV, hazard ratio (HR) 1.99, 95% confidence interval (CI) 1.27-3.12; P = 0.003; ViMAC vs. ViV, HR 5.29, 95% CI 3.29-8.51; P < 0.001].Entities:
Mesh：
Year: 2019 PMID： 30357365 DOI： 10.1093/eurheartj/ehy590
Source DB: PubMed Journal: Eur Heart J ISSN： 0195-668X Impact factor: 29.983