Matheus Simonato1,2, Brian Whisenant3, Henrique Barbosa Ribeiro4, John G Webb5, Ran Kornowski6, Mayra Guerrero7, Harindra Wijeysundera8, Lars Søndergaard9, Ole De Backer9, Pedro Villablanca10, Charanjit Rihal7, Mackram Eleid7, Jörg Kempfert11, Axel Unbehaun11, Magdalena Erlebach12, Filip Casselman13, Matti Adam14, Matteo Montorfano15, Marco Ancona15, Francesco Saia16, Timm Ubben17, Felix Meincke17, Massimo Napodano18, Pablo Codner6, Joachim Schofer19, Marc Pelletier20, Anson Cheung5, Mony Shuvy21, José Honório Palma2,4, Diego Felipe Gaia2, Alison Duncan22, David Hildick-Smith23, Verena Veulemans24, Jan-Malte Sinning25, Yaron Arbel26, Luca Testa27, Arend de Weger28, Helene Eltchaninoff29, Thibault Hemery29, Uri Landes5, Didier Tchetche30, Nicolas Dumonteil30, Josep Rodés-Cabau31, Won-Keun Kim32, Konstantinos Spargias33, Panagiota Kourkoveli33, Ori Ben-Yehuda1,34, Rui Campante Teles35, Marco Barbanti36, Claudia Fiorina37, Arun Thukkani38, G Burkhard Mackensen39, Noah Jones40, Patrizia Presbitero41, Anna Sonia Petronio42, Abdelhakim Allali43, Didier Champagnac44, Sabine Bleiziffer45, Tanja Rudolph, Alessandro Iadanza46, Stefano Salizzoni47, Marco Agrifoglio48, Luis Nombela-Franco49, Nikolaos Bonaros50, Malek Kass51, Giuseppe Bruschi52, Nicolas Amabile53, Adnan Chhatriwalla54, Antonio Messina55, Sameer A Hirji56, Martin Andreas57, Robert Welsh58, Wolfgang Schoels59, Farrel Hellig60, Stephan Windecker61, Stefan Stortecky61, Francesco Maisano62, Gregg W Stone1,63, Danny Dvir. 1. The Cardiovascular Research Foundation, New York (M.Simonato, G.W.S., O.B-Y.). 2. Escola Paulista de Medicina - Universidade Federal de São Paulo, São Paulo, Brazil (M.Simonato, J.H.P., D.F.G.). 3. Intermountain Healthcare, Murray, UT (B.W.). 4. Instituto do Coração da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil (H.B.R., J.H.P.). 5. St. Paul's Hospital, Vancouver, Canada (J.G.W., A.Cheung, U.L.). 6. Rabin Medical Center, Petah Tikva, Israel (R.K., P.C.). 7. Mayo Clinic, Rochester, MN (M.G., C.R., M.Eleid). 8. Sunnybrook Hospital, Toronto, Canada (H.W). 9. Rigshospitalet, Copenhagen, Denmark (L.S., O.DB.). 10. Henry Ford Hospital, Detroit, MI (P.V.). 11. Deutsches Herzzentrum Berlin, Berlin, Germany (J.K., A.U.). 12. Deutsches Herzzentrum München, Munich, Germany (M.Erlebach). 13. Onze-Lieve-Vrouwziekenhuis, Aalst, Belgium (F.C.). 14. Uniklinik Köln, Köln, Germany (M.Adam). 15. I.R.C.C.S. Ospedale San Raffaele, Milan, Italy (M.M., M.Ancona). 16. Policlinico Sant'Orsola-Malpighi, Bologna, Italy (F.S.). 17. Asklepios Klinik St. Georg, Hamburg, Germany (T.U., F.Meincke). 18. Università degli Studi di Padova, Padova, Italy (M.N.). 19. Medizinisches Versorgungszentrum, Hamburg, Germany (J.S.). 20. University Hospitals Harrington Heart and Vascular Institute, Cleveland, OH (M.P.). 21. Hadassah Medical Center, Jerusalem, Israel (M.Shuvy). 22. The Royal Brompton Hospital, London, United Kingdom (A.D.). 23. Brighton and Sussex University Hospitals, Brighton, United Kingdom (D.H-S.). 24. Universitätsklinikum Düsseldorf, Düsseldorf, Germany (V.V.). 25. Universitätsklinikum Bonn, Bonn, Germany (J-M.S.). 26. Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel (Y.A.). 27. I.R.C.C.S. Policlinico San Donato, Milan, Italy (L.T.). 28. Leids Universitair Medisch Centrum, Leiden, the Netherlands (A.d.W.). 29. Rouen University Hospital, Rouen, France (H.E., T.H.). 30. Clinique Pasteur, Toulouse, France (D.T., N.D.). 31. Institut Universitaire de Cardiologie et de Pneumologie de Québec, Québec City, Canada (J.R-C.). 32. Kerckhoff-Klinik, Bad Nauheim, Germany (W-K.K.). 33. Hygeia Hospital, Athens, Greece (K.S., P.K.). 34. University of California San Diego (O.B-Y.). 35. Hospital de Santa Cruz, Lisboa, Portugal (R.C.T.). 36. Università degli Studi di Catania, Catania, Italy (M.B.). 37. Spedali Civili Brescia, Brescia, Italy (C.F.). 38. Central Maine Healthcare, Lewiston (A.T.). 39. University of Washington, Seattle (G.B.M.). 40. Mount Carmel Health System, Columbus, OH (N.J.). 41. Humanitas, Milan, Italy (P.P.). 42. Università di Pisa, Pisa, Italy (A.S.P.). 43. Segeberger Kliniken, Bad Segeberg, Germany (A.A.). 44. Cardiologie Tonkin, Villeurbanne, France (D.C.). 45. Herz- und Diabeteszentrum Nordrhein-Westfalen, Bad Oeynhausen, Germany (S.B.). 46. Azienda Ospedaliera Universitaria Senese, Siena, Italy (A.I.). 47. Città della Salute e della Scienza - "Molinette" Hospital, Torino, Italy (S.Salizzoni). 48. Centro Cardiologico Monzino, Milan, Italy (M.Agrifoglio). 49. Hospital Clínico San Carlos, Madrid, Spain (L.N-F.). 50. Medizinische Universität Innsbruck, Innsbruck, Austria (N.B.). 51. University of Manitoba, Winnipeg, Canada (M.K.). 52. Ospedale Niguarda Ca' Granda, Milan, Italy (G.B.). 53. Institut Mutualiste Montsouris, Paris, France (N.A.). 54. Saint Luke's Mid America Heart Institute, Kansas City, MO (A.Chhatriwalla). 55. Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy (A.M.). 56. Brigham and Women's Hospital, Boston, MA (S.A.H.). 57. Medizinische Universität Wien, Vienna, Austria (M.Andreas). 58. University of Alberta, Edmonton, Canada (R.W.W). 59. Evangelisches Klinikum Niederrhein, Duisburg, Germany (W.S.). 60. Sunninghill Hospital, Johannesburg, South Africa (F.H.). 61. Inselspital, Bern, Switzerland (S.W., S.Stortecky). 62. Universitätsspital Zürich, Zurich, Switzerland (F.Maisano). 63. The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York (G.W.S.).
Abstract
BACKGROUND: Mitral valve-in-valve (ViV) and valve-in-ring (ViR) are alternatives to surgical reoperation in patients with recurrent mitral valve failure after previous surgical valve repair or replacement. Our aim was to perform a large-scale analysis examining midterm outcomes after mitral ViV and ViR. METHODS: Patients undergoing mitral ViV and ViR were enrolled in the Valve-in-Valve International Data Registry. Cases were performed between March 2006 and March 2020. Clinical endpoints are reported according to the Mitral Valve Academic Research Consortium (MVARC) definitions. Significant residual mitral stenosis (MS) was defined as mean gradient ≥10 mm Hg and significant residual mitral regurgitation (MR) as ≥ moderate. RESULTS: A total of 1079 patients (857 ViV, 222 ViR; mean age 73.5±12.5 years; 40.8% male) from 90 centers were included. Median STS-PROM score 8.6%; median clinical follow-up 492 days (interquartile range, 76-996); median echocardiographic follow-up for patients that survived 1 year was 772.5 days (interquartile range, 510-1211.75). Four-year Kaplan-Meier survival rate was 62.5% in ViV versus 49.5% for ViR (P<0.001). Mean gradient across the mitral valve postprocedure was 5.7±2.8 mm Hg (≥5 mm Hg; 61.4% of patients). Significant residual MS occurred in 8.2% of the ViV and 12.0% of the ViR patients (P=0.09). Significant residual MR was more common in ViR patients (16.6% versus 3.1%; P<0.001) and was associated with lower survival at 4 years (35.1% versus 61.6%; P=0.02). The rates of Mitral Valve Academic Research Consortium-defined device success were low for both procedures (39.4% total; 32.0% ViR versus 41.3% ViV; P=0.01), mostly related to having postprocedural mean gradient ≥5 mm Hg. Correlates for residual MS were smaller true internal diameter, younger age, and larger body mass index. The only correlate for residual MR was ViR. Significant residual MS (subhazard ratio, 4.67; 95% CI, 1.74-12.56; P=0.002) and significant residual MR (subhazard ratio, 7.88; 95% CI, 2.88-21.53; P<0.001) were both independently associated with repeat mitral valve replacement. CONCLUSIONS: Significant residual MS and/or MR were not infrequent after mitral ViV and ViR procedures and were both associated with a need for repeat valve replacement. Strategies to improve postprocedural hemodynamics in mitral ViV and ViR should be further explored.
BACKGROUND: Mitral valve-in-valve (ViV) and valve-in-ring (ViR) are alternatives to surgical reoperation in patients with recurrent mitral valve failure after previous surgical valve repair or replacement. Our aim was to perform a large-scale analysis examining midterm outcomes after mitral ViV and ViR. METHODS:Patients undergoing mitral ViV and ViR were enrolled in the Valve-in-Valve International Data Registry. Cases were performed between March 2006 and March 2020. Clinical endpoints are reported according to the Mitral Valve Academic Research Consortium (MVARC) definitions. Significant residual mitral stenosis (MS) was defined as mean gradient ≥10 mm Hg and significant residual mitral regurgitation (MR) as ≥ moderate. RESULTS: A total of 1079 patients (857 ViV, 222 ViR; mean age 73.5±12.5 years; 40.8% male) from 90 centers were included. Median STS-PROM score 8.6%; median clinical follow-up 492 days (interquartile range, 76-996); median echocardiographic follow-up for patients that survived 1 year was 772.5 days (interquartile range, 510-1211.75). Four-year Kaplan-Meier survival rate was 62.5% in ViV versus 49.5% for ViR (P<0.001). Mean gradient across the mitral valve postprocedure was 5.7±2.8 mm Hg (≥5 mm Hg; 61.4% of patients). Significant residual MS occurred in 8.2% of the ViV and 12.0% of the ViR patients (P=0.09). Significant residual MR was more common in ViR patients (16.6% versus 3.1%; P<0.001) and was associated with lower survival at 4 years (35.1% versus 61.6%; P=0.02). The rates of Mitral Valve Academic Research Consortium-defined device success were low for both procedures (39.4% total; 32.0% ViR versus 41.3% ViV; P=0.01), mostly related to having postprocedural mean gradient ≥5 mm Hg. Correlates for residual MS were smaller true internal diameter, younger age, and larger body mass index. The only correlate for residual MR was ViR. Significant residual MS (subhazard ratio, 4.67; 95% CI, 1.74-12.56; P=0.002) and significant residual MR (subhazard ratio, 7.88; 95% CI, 2.88-21.53; P<0.001) were both independently associated with repeat mitral valve replacement. CONCLUSIONS: Significant residual MS and/or MR were not infrequent after mitral ViV and ViR procedures and were both associated with a need for repeat valve replacement. Strategies to improve postprocedural hemodynamics in mitral ViV and ViR should be further explored.
Authors: Laura Besola; Anson Cheung; Jian Ye; Myriam Akodad; Andrew Chatfield; Gnalini Sathananthan; Robert Moss; John Webb Journal: Ann Cardiothorac Surg Date: 2021-09
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: Tamer Owais; Mohammad El Garhy; Sebastian Elvinger; Eva Harmel; Tatiana Maria Sequeria Gross; Harald Lapp; Thomas Kuntze; Wolfgang Von Scheidt; Evaldas Girdauskas; Mahmoud Al-Jassem; Philipp Lauten Journal: Egypt Heart J Date: 2022-03-28