Mayra Guerrero1, Sreekanth Vemulapalli2, Qun Xiang2, Dee Dee Wang3, Mackram Eleid1, Allison K Cabalka1, Gurpreet Sandhu1, Michael Salinger4, Hyde Russell5, Adam Greenbaum6, Susheel Kodali7, Isaac George8, Danny Dvir9, Brian Whisenant10, Mark J Russo11, Ashish Pershad12, Kenith Fang13, Megan Coylewright14, Pinak Shah15, Vasilis Babaliaros6, Jaffar M Khan16, Carl Tommaso17, Jorge Saucedo, Saibal Kar18, Rajj Makkar18, Michael Mack19, David Holmes1, Martin Leon7, Vinayak Bapat8, Vinod H Thourani20, Charanjit Rihal1, William O'Neill3, Ted Feldman17. 1. Department of Cardiovascular Medicine, Mayo Clinic Hospital, Rochester, MN (M.G., M.E., A.K.C., G.S., D.H., C.R.). 2. Duke Clinical Research Institute, Durham, NC (S.V., Q.X.). 3. Center for Structural Heart Disease, Henry Ford Hospital (D.D.W., W.O.). 4. Division of Cardiology, Froedtert Medical College of Wisconsin, Milwaukee (M.S.). 5. Division of Cardiovascular Surgery (H.R.), NorthShore University Health System, Evanston, IL. 6. Structural Heart and Valve Center, Emory University, Atlanta, GA (A.G., V.B.). 7. Division of Cardiology (S.K., M.L.). 8. Department of Surgery, Columbia University Medical Center, New York (I.G., V.B.). 9. Division of Cardiology, University of Washington Medical Center, Seattle (D.D.). 10. Division of Cardiology, Intermountain Heart Institute, Salt Lake City, UT (B.W.). 11. Department of Surgery, Rutgers Robert Wood Johnson Medical School in New Brunswick, NJ (M.J.R.). 12. Division of Cardiology (A.P.), Banner University Medical Center, Phoenix, AZ. 13. Department of Surgery (K.F.), Banner University Medical Center, Phoenix, AZ. 14. Division of Cardiology, Dartmouth-Hitchcock Medical Center, Lebanon, NH (M.C.). 15. Division of Cardiology, Brigham and Women's Hospital, Brighton, MA (P.S.). 16. Cardiovascular and Pulmonary Branch, Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD (J.M.K.). 17. Division of Cardiology (C.T., T.F.), NorthShore University Health System, Evanston, IL. 18. Division of Cardiology, Cedar's Sinai Medical Center, Los Angeles, CA (S.K., R.M.). 19. Department of Surgery, Heart Hospital Baylor Plano, Baylor Healthcare System, TX (M.M.). 20. Department of Cardiovascular Surgery, Marcus Valve Center, Piedmont Heart Institute, Atlanta, GA (V. H.T.).
Abstract
BACKGROUND: Transcatheter mitral valve replacement using aortic transcatheter heart valves has recently become an alternative for patients with degenerated mitral bioprostheses, failed surgical repairs with annuloplasty rings or severe mitral annular calcification who are poor surgical candidates. Outcomes of these procedures are collected in the Society of Thoracic Surgeons/American College of Cardiology/Transcatheter Valve Therapy Registry. A comprehensive analysis of mitral valve-in-valve (MViV), mitral valve-in-ring (MViR), and valve-in-mitral annular calcification (ViMAC) outcomes has not been performed. We sought to evaluate short-term outcomes of early experience with MViV, MViR, and ViMAC in the United States. METHODS: Retrospective analysis of data from the Society of Thoracic Surgeons/American College of Cardiology Transcatheter Valve Therapy Registry. RESULTS: Nine hundred three high-risk patients (median Society of Thoracic Surgeons score 10%) underwent MViV (n=680), MViR (n=123), or ViMAC (n=100) between March 2013 and June 2017 at 172 hospitals. Median age was 75 years, 59.2% female. Technical and procedural success were higher in MViV. Left ventricular outflow tract obstruction occurred more frequently with ViMAC (ViMAC=10%, MViR=4.9%, MViV=0.7%; P<0.001). In-hospital mortality (MViV=6.3%, MViR=9%, ViMAC=18%; P=0.004) and 30-day mortality (MViV=8.1%, MViR=11.5%, ViMAC=21.8%; P=0.003) were higher in ViMAC. At 30-day follow-up, median mean mitral valve gradient was 7 mm Hg, most patients (96.7%) had mitral regurgitation grade ≤1 (+) and were in New York Heart Association class I to II (81.7%). CONCLUSIONS: MViV using aortic balloon-expandable transcatheter heart valves is associated with a low complication rate, a 30-day mortality lower than predicted by the Society of Thoracic Surgeons score, and superior short-term outcomes than MViR and ViMAC. At 30 days, patients in all groups experienced improvement of symptoms, and valve performance remained stable. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT02245763.
BACKGROUND: Transcatheter mitral valve replacement using aortic transcatheter heart valves has recently become an alternative for patients with degenerated mitral bioprostheses, failed surgical repairs with annuloplasty rings or severe mitral annular calcification who are poor surgical candidates. Outcomes of these procedures are collected in the Society of Thoracic Surgeons/American College of Cardiology/Transcatheter Valve Therapy Registry. A comprehensive analysis of mitral valve-in-valve (MViV), mitral valve-in-ring (MViR), and valve-in-mitral annular calcification (ViMAC) outcomes has not been performed. We sought to evaluate short-term outcomes of early experience with MViV, MViR, and ViMAC in the United States. METHODS: Retrospective analysis of data from the Society of Thoracic Surgeons/American College of Cardiology Transcatheter Valve Therapy Registry. RESULTS: Nine hundred three high-risk patients (median Society of Thoracic Surgeons score 10%) underwent MViV (n=680), MViR (n=123), or ViMAC (n=100) between March 2013 and June 2017 at 172 hospitals. Median age was 75 years, 59.2% female. Technical and procedural success were higher in MViV. Left ventricular outflow tract obstruction occurred more frequently with ViMAC (ViMAC=10%, MViR=4.9%, MViV=0.7%; P<0.001). In-hospital mortality (MViV=6.3%, MViR=9%, ViMAC=18%; P=0.004) and 30-day mortality (MViV=8.1%, MViR=11.5%, ViMAC=21.8%; P=0.003) were higher in ViMAC. At 30-day follow-up, median mean mitral valve gradient was 7 mm Hg, most patients (96.7%) had mitral regurgitation grade ≤1 (+) and were in New York Heart Association class I to II (81.7%). CONCLUSIONS: MViV using aortic balloon-expandable transcatheter heart valves is associated with a low complication rate, a 30-day mortality lower than predicted by the Society of Thoracic Surgeons score, and superior short-term outcomes than MViR and ViMAC. At 30 days, patients in all groups experienced improvement of symptoms, and valve performance remained stable. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT02245763.
Authors: Matti Adam; Elmar Kuhn; Hendrik Wienemann; Victor Mauri; Laurin Ochs; Maria Isabel Körber; Kaveh Eghbalzadeh; Christos Iliadis; Marcel Halbach; Thorsten Wahlers; Stephan Baldus Journal: Clin Res Cardiol Date: 2022-09-15 Impact factor: 6.138
Authors: Brian Whisenant; Samir R Kapadia; Mackram F Eleid; Susheel K Kodali; James M McCabe; Amar Krishnaswamy; Michael Morse; Richard W Smalling; Mark Reisman; Michael Mack; William W O'Neill; Vinayak N Bapat; Martin B Leon; Charanjit S Rihal; Raj R Makkar; Mayra Guerrero Journal: JAMA Cardiol Date: 2020-11-01 Impact factor: 14.676
Authors: Adam B Greenbaum; John C Lisko; Patrick T Gleason; Norihiko Kamioka; Derek P Metcalf; Max A Greenbaum; Gaetano Paone; Kendra J Grubb; Robert J Lederman; Vasilis C Babaliaros Journal: JACC Cardiovasc Interv Date: 2020-10-26 Impact factor: 11.195