1
|
Guerrero ME, Bapat VN, Mahoney P, Krishnaswamy A, Eleid MF, Eng MH, Yadav P, Coylewright M, Makkar R, Szerlip M, Nazif T, Kodali S, George I, Greenbaum A, Babaliaros V, Kapadia S, Rihal CS, Whisenant B, Thourani VH, McCabe JM. Contemporary 1-Year Outcomes of Mitral Valve-in-Ring With Balloon-Expandable Aortic Transcatheter Valves in the U.S. JACC Cardiovasc Interv 2024; 17:874-886. [PMID: 38599690 DOI: 10.1016/j.jcin.2024.02.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 01/31/2024] [Accepted: 02/07/2024] [Indexed: 04/12/2024]
Abstract
BACKGROUND Adequate valve performance after surgical mitral valve repair with an annuloplasty ring is not always sustained over time. The risk of repeat mitral valve surgery may be high in these patients. Transcatheter mitral valve-in-ring (MViR) is emerging as an alternative for high-risk patients. OBJECTIVES The authors sought to assess contemporary outcomes of MViR using third-generation balloon-expandable aortic transcatheter heart valves. METHODS Patients who underwent MViR and were enrolled in the STDS/ACC TVT (Society of Thoracic Surgeons/American College of Cardiology Transcatheter Valve Therapy) Registry between August 2015 and December 2022 were analyzed. RESULTS A total of 820 patients underwent MViR at 236 sites, mean age was 72.2 ± 10.4 years, 50.9% were female, mean STS score was 8.2% ± 6.9%, and most (78%) were in NYHA functional class III to IV. Mean left ventricular ejection fraction was 47.8% ± 14.2%, mean mitral gradient was 8.9 ± 7.0 mm Hg, and 75.5% had ≥ moderate mitral regurgitation. Access was transseptal in 93.9% with 88% technical success. All-cause mortality at 30 days was 8.3%, and at 1 year, 22.4%, with a reintervention rate of 9.1%. At 1-year follow-up, 75.6% were NYHA functional class I to II, Kansas City Cardiomyopathy Questionnaire score increased by 25.9 ± 29.1 points, mean mitral valve gradient was 8.4 ± 3.4 mm Hg, and 91.7% had ≤ mild mitral regurgitation. CONCLUSIONS MViR with third-generation balloon-expandable aortic transcatheter heart valves is associated with a significant reduction in mitral regurgitation and improvement in symptoms at 1 year, but with elevated valvular gradients and a high reintervention rate. MViR is a reasonable alternative for high-risk patients unable undergo surgery who have appropriate anatomy for the procedure. (STS/ACC TVT Registry Mitral Module [TMVR]; NCT02245763).
Collapse
Affiliation(s)
- Mayra E Guerrero
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA.
| | - Vinayak N Bapat
- Department of Cardiothoracic Surgery, Allina Health Minneapolis Heart Institute at Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Paul Mahoney
- Division of Cardiology, Department of Cardiovascular Services, Brody School of Medicine, East Carolina University, Greenville, North Carolina, USA
| | | | - Mackram F Eleid
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Marvin H Eng
- Division of Cardiology, Banner University Medical Center, Phoenix, Arizona, USA
| | - Pradeep Yadav
- Division of Cardiology, Marcus Valve Center, Piedmont Heart Institute, Atlanta, Georgia, USA
| | - Megan Coylewright
- Division of Cardiology Erlanger Health System, Chattanooga, Tennessee, USA
| | - Raj Makkar
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Molly Szerlip
- Baylor Scott and White, The Heart Hospital, Plano, Texas, USA
| | - Tamim Nazif
- Cardiology Department, New York-Presbyterian/Columbia University Medical Center, New York, New York
| | - Susheel Kodali
- Cardiology Department, New York-Presbyterian/Columbia University Medical Center, New York, New York
| | - Isaac George
- Department of Surgery, Columbia University Medical Center, New York, New York, USA
| | - Adam Greenbaum
- Emory Structural Heart and Valve Center, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Vasilis Babaliaros
- Emory Structural Heart and Valve Center, Emory University School of Medicine, Atlanta, Georgia, USA
| | | | - Charanjit S Rihal
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Brian Whisenant
- Division of Cardiology, Intermountain Heart Institute, Salt Lake City, Utah, USA
| | - Vinod H Thourani
- Department of Cardiovascular Surgery, Marcus Heart and Vascular Center, Piedmont Heart Institute, Atlanta, Georgia, USA
| | - James M McCabe
- Division of Cardiology, University of Washington Medical Center, Seattle, Washington, USA
| |
Collapse
|
2
|
Elbadawi A, Tan BEX, Sammour Y, Saad M, Omer M, Baron SJ, Sharaf B, Abbott JD, Gordon PC. Sex-related differences in the trends and outcomes of trans-septal transcatheter mitral valve replacement: Insights from the National Readmissions Database. Catheter Cardiovasc Interv 2022; 99:1636-1644. [PMID: 35132765 DOI: 10.1002/ccd.30072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 11/26/2021] [Accepted: 12/25/2021] [Indexed: 11/11/2022]
Abstract
BACKGROUND There is a paucity of data regarding the sex-related differences in the trends and outcomes of trans-septal transcatheter mitral valve replacement (TS-TMVR). METHODS The Nationwide Readmissions Database (2015-2018) was queried for admissions for TS-TMVR. Propensity matched analysis was conducted to compare outcomes with hospitalizations for TS-TMVR among women versus men. The main study outcome was in-hospital mortality. RESULTS Our final analysis included 2063 hospitalizations for TS-TMVR; of whom, 58.1% were women. The proportion of women among those undergoing TS-TMVR increased from 50% in 2015 to 60.2% in 2018 (Ptrend = 0.04). Compared with men, women undergoing TS-TMVR were slightly younger, and had a distinct profile of comorbidities. After matching, there was no significant difference in in-hospital mortality among women versus men undergoing TS-TMVR (7.8% vs. 6.1%, OR = 1.30; 95% CI: 0.79-2.13). Subgroup analyzes showed an interaction toward higher mortality with women versus men among patients with CKD (Pinteraction = 0.07). There were no significant differences between women and men in in-hospital complications or length of stay after TS-TMVR. Compared with men, women undergoing TS-TMVR were more likely to be discharged to a nursing facility (17.7% vs. 11.5%, p = 0.01) and had higher rates of 30-day readmissions (22.4% vs. 13.6%, p = 0.01). CONCLUSION This nationwide analysis showed an increase in the proportion of women among patients undergoing TS-TMVR during the study years. There were no differences in in-hospital mortality, in-hospital complications, or length of stay between both sexes following TS-TMVR. Women were more likely to be discharged to nursing facilities and had higher rates of readmission at 30 days even after propensity matching.
Collapse
Affiliation(s)
- Ayman Elbadawi
- Division of Cardiology, Baylor College of Medicine, Houston, Texas, USA
| | - Bryan E-Xin Tan
- Department of Internal Medicine, Rochester General Hospital, Rochester, New York, USA
| | - Yasser Sammour
- Department of Internal Medicine, University of Missouri Kansas City, Kansas City, Missouri, USA
| | - Marwan Saad
- Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Mohamed Omer
- Division of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Suzanne J Baron
- Division of Cardiovascular Medicine, Department of Medicine, Lahey Hospital and Medical Center, Burlington, Massachusetts, USA
| | - Barry Sharaf
- Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - J Dawn Abbott
- Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Paul C Gordon
- Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| |
Collapse
|
3
|
You T, Wang W, Yi K, Gao J, Zhang X, He SE, Xu XM, Ma YH, Li XY. Transcatheter mitral valve replacement for degenerated mitral valve bioprostheses, failure of mitral valvuloplasty and native valve with severe mitral annulus calcification: a systematic review and meta-analysis. J Cardiothorac Surg 2021; 16:293. [PMID: 34629106 PMCID: PMC8504093 DOI: 10.1186/s13019-021-01677-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 09/28/2021] [Indexed: 01/04/2023] Open
Abstract
Background Although transcatheter technology has achieved some success in the field of mitral valves, the feasibility of applying it to patients with degenerated mitral valve bioprostheses (valve-in-valve, ViV), failure of mitral valvuloplasty (valve-in-ring, ViR) and serious mitral annulus calcification (vale-in-MAC, ViMAC) has not been effectively evaluated. Methods By searching published literature before December 5, 2020 in four databases, we found all the literature related to the evaluation of feasibility assessment of TMViV, TMViR and TMViMAC. Outcomes focused on all-cause mortality within 30 days, bleeding and LVOT obstruction. Results A total of six studies were included, and all of them were followed up for at least 30 days. After analysis of the ViV–ViR group, we obtained the following results: the all-cause mortality within 30 days of the ViV group was lower than that of the ViR group. Life-threatening or fatal bleeding was more likely to occur in the ViR group after surgery. At the same time, the ViR group was more prone to left ventricular outflow tract obstruction. However, in the ViMAC–ViR group, only the all-cause mortality within 30 days and stroke were statistically significant. In the indirect comparison, we found that TMViV had the best applicability, followed by TMViR. There were few TMViMAC available for analysis, and it requires further studies to improve the accuracy of the results. Conclusion TMViV and TMViR had good applicability and could benefit patients who underwent repeat valve surgery. The feasibility of TMViMAC needs to be further explored and improved. Supplementary Information The online version contains supplementary material available at 10.1186/s13019-021-01677-7.
Collapse
Affiliation(s)
- Tao You
- Department of Cardiovascular Surgery, Gansu Provincial Hospital, No. 204, Donggang West Road, Lanzhou City, 730000, Gansu Province, China. .,Gansu International Scientific and Technological Cooperation Base of Diagnosis and Treatment of Congenital Heart Disease, Lanzhou, China.
| | - Wei Wang
- Gansu International Scientific and Technological Cooperation Base of Diagnosis and Treatment of Congenital Heart Disease, Lanzhou, China.,The First Clinical Medical College of Lanzhou University, Lanzhou, China
| | - Kang Yi
- Department of Cardiovascular Surgery, Gansu Provincial Hospital, No. 204, Donggang West Road, Lanzhou City, 730000, Gansu Province, China.,Gansu International Scientific and Technological Cooperation Base of Diagnosis and Treatment of Congenital Heart Disease, Lanzhou, China
| | - Jie Gao
- Gansu International Scientific and Technological Cooperation Base of Diagnosis and Treatment of Congenital Heart Disease, Lanzhou, China.,The First Clinical Medical College of Lanzhou University, Lanzhou, China
| | - Xin Zhang
- Gansu International Scientific and Technological Cooperation Base of Diagnosis and Treatment of Congenital Heart Disease, Lanzhou, China.,The First School of Clinical Medical of Gansu University of Chinese Medicine, Lanzhou, China
| | - Shao-E He
- Gansu International Scientific and Technological Cooperation Base of Diagnosis and Treatment of Congenital Heart Disease, Lanzhou, China.,The Second Clinical Medical College of Lanzhou University, Lanzhou, China
| | - Xiao-Min Xu
- Gansu International Scientific and Technological Cooperation Base of Diagnosis and Treatment of Congenital Heart Disease, Lanzhou, China.,The First Clinical Medical College of Lanzhou University, Lanzhou, China
| | - Yu-Hu Ma
- Gansu International Scientific and Technological Cooperation Base of Diagnosis and Treatment of Congenital Heart Disease, Lanzhou, China.,The First Clinical Medical College of Lanzhou University, Lanzhou, China
| | - Xin-Yao Li
- Gansu International Scientific and Technological Cooperation Base of Diagnosis and Treatment of Congenital Heart Disease, Lanzhou, China.,The First Clinical Medical College of Lanzhou University, Lanzhou, China
| |
Collapse
|
4
|
Elbadawi A, Mahta D, Elgendy IY, Dang AT, Mahmoud M, Iskandar M, Kaple R, Al-Azizi K, Szerlip M, Kayani W, Barker CM, Jneid H. Trends in utilization, outcomes, and readmissions after transcatheter mitral valve replacement. Catheter Cardiovasc Interv 2021; 99:906-914. [PMID: 34569695 DOI: 10.1002/ccd.29963] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Revised: 08/24/2021] [Accepted: 09/18/2021] [Indexed: 11/07/2022]
Abstract
BACKGROUND There is a paucity of real-world data regarding the temporal trends and outcomes of trans-septal transcatheter mitral valve replacement (TS-TMVR) in the United States (US). METHODS We queried the Nationwide Readmissions Database (October 2015 to December 2018) for patients undergoing TS-TMVR procedures. We reported the temporal trends in the utilization, in-hospital outcomes and 30-day readmissions after TS-TMVR. The main study outcome was in-hospital mortality. RESULTS There was an increase in the number of TS-TMVR procedures over time (48 in 2015 vs. 978 in 2018, Ptrend < 0.001), with a notable increase in the proportion of women (Ptrend = 0.04) and the prevalence of diabetes (Ptrend = 0.03). There was an increase in the number of centers performing TS-TMVR (21 in 2015 vs. 164 in 2018, Ptrend < 0.001). The overall in-hospital mortality was 7.2% with no change over time (6.3% in 2015 vs. to 5.2% in 2018, Ptrend = 0.67). There was no change in the frequency of in-hospital complications after TS-TMVR; however, the median length of stay has decreased over time. The overall 30-day readmission rate was 17.8%, with no change during the study years. The most frequent cause for 30-day readmission after TS-TMVR was acute heart failure followed by bleeding and infection-related complications. Prior coagulopathy and small-sized hospitals were independently associated with higher in-hospital mortality and 30-day readmissions. CONCLUSION This nationwide observational analysis of real-world data showed an increase in the number of TS-TMVR procedures over time, which is now performed at a greater number of centers. There was no change in the rate of in-hospital mortality, complications or 30-day readmissions; but a significant reduction in the length of hospital stay over time was noted. As the number of TS-TMVR continue to expand, these data provide a perspective on the early experience with this procedure.
Collapse
Affiliation(s)
- Ayman Elbadawi
- Section of Cardiology, Baylor School of Medicine, Houston, Texas, USA
| | - Dhruv Mahta
- Section of Cardiology, Baylor School of Medicine, Houston, Texas, USA
| | - Islam Y Elgendy
- Department of Medicine, Weill Cornell Medicine-Qatar, Doha, Qatar
| | - Alexander T Dang
- Department of Internal Medicine, University of Texas Medical Branch, Galveston, Texas, USA
| | - Mona Mahmoud
- Department of Internal Medicine, Central Michigan University Health, Saginaw, Michigan, USA
| | - Mina Iskandar
- Department of Cardiovascular Medicine, Yale New Haven Hospital, New Haven, Connecticut, USA
| | - Ryan Kaple
- Department of Cardiovascular Medicine, Yale New Haven Hospital, New Haven, Connecticut, USA
| | - Karim Al-Azizi
- Cardiovascular Research Department, Baylor Scott and White the Heart Hospital, Plano, Texas, USA
| | - Molly Szerlip
- Cardiovascular Research Department, Baylor Scott and White the Heart Hospital, Plano, Texas, USA
| | - Waleed Kayani
- Section of Cardiology, Baylor School of Medicine, Houston, Texas, USA
| | - Colin M Barker
- Vanderbilt Heart and Vascular Institute, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Hani Jneid
- Section of Cardiology, Baylor School of Medicine, Houston, Texas, USA
| |
Collapse
|
5
|
Fu G, Zhou Z, Huang S, Chen G, Liang M, Huang L, Wu Z. Mitral Valve Surgery in Patients With Rheumatic Heart Disease: Repair vs. Replacement. Front Cardiovasc Med 2021; 8:685746. [PMID: 34124209 PMCID: PMC8193043 DOI: 10.3389/fcvm.2021.685746] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 05/05/2021] [Indexed: 11/13/2022] Open
Abstract
Background: High morbidity and mortality caused by rheumatic heart disease (RHD) are global burdens, especially in low-income and developing countries. Whether mitral valve repair (MVP) benefits RHD patients remains controversial. Thus, we performed a meta-analysis to compare the perioperative and long-term outcomes of MVP and mitral valve replacement (MVR) in RHD patients. Methods and Results: A systematic literature search was conducted in major databases, including Embase, PubMed, and the Cochrane Library, until 17 December 2020. Studies comparing MVP and MVR in RHD patients were retained. Outcomes included early mortality, long-term survival, freedom from reoperation, postoperative infective endocarditis, thromboembolic events, hemorrhagic events, and freedom from valve-related adverse events. Eleven studies that met the inclusion criteria were included. Of a total of 5,654 patients, 1,951 underwent MVP, and 3,703 underwent MVR. Patients who undergo MVP can benefit from a higher long-term survival rate (HR 0.72; 95% CI, 0.55-0.95; P = 0.020; I 2 = 44%), a lower risk of early mortality (RR 0.62; 95% CI, 0.38-1.01; P = 0.060; I 2 = 42%), and the composite outcomes of valve-related adverse events (HR 0.60; 95% CI, 0.38-0.94; P = 0.030; I 2 = 25%). However, a higher risk of reoperation was observed in the MVP group (HR 2.60; 95% CI, 1.89-3.57; P<0.001; I 2 = 4%). Patients who underwent concomitant aortic valve replacement (AVR) in the two groups had comparable long-term survival rates, although the trend still favored MVP. Conclusions: For RHD patients, MVP can reduce early mortality, and improve long-term survival and freedom from valve-related adverse events. However, MVP was associated with a higher risk of reoperation. Systematic Review Registration: https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=228307.
Collapse
Affiliation(s)
- Guangguo Fu
- Department of Cardiac Surgery, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.,NHC Key Laboratory of Assisted Circulation, Sun Yat-sen University, Guangzhou, China
| | - Zhuoming Zhou
- Department of Cardiac Surgery, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.,NHC Key Laboratory of Assisted Circulation, Sun Yat-sen University, Guangzhou, China
| | - Suiqing Huang
- Department of Cardiac Surgery, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.,NHC Key Laboratory of Assisted Circulation, Sun Yat-sen University, Guangzhou, China
| | - Guangxian Chen
- Department of Cardiac Surgery, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.,NHC Key Laboratory of Assisted Circulation, Sun Yat-sen University, Guangzhou, China
| | - Mengya Liang
- Department of Cardiac Surgery, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.,NHC Key Laboratory of Assisted Circulation, Sun Yat-sen University, Guangzhou, China
| | - Lin Huang
- Department of Cardiac Surgery, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.,NHC Key Laboratory of Assisted Circulation, Sun Yat-sen University, Guangzhou, China
| | - Zhongkai Wu
- Department of Cardiac Surgery, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.,NHC Key Laboratory of Assisted Circulation, Sun Yat-sen University, Guangzhou, China
| |
Collapse
|
6
|
Guerrero M, Pursnani A, Narang A, Salinger M, Wang DD, Eleid M, Kodali SK, George I, Satler L, Waksman R, Meduri CU, Rajagopal V, Inglessis I, Palacios I, Reisman M, Eng MH, Russell HM, Pershad A, Fang K, Kar S, Makkar R, Saucedo J, Pearson P, Bokhary U, Kaptzan T, Lewis B, Tommaso C, Krause P, Thaden J, Oh J, Lang RM, Hahn RT, Leon MB, O'Neill WW, Feldman T, Rihal C. Prospective Evaluation of Transseptal TMVR for Failed Surgical Bioprostheses: MITRAL Trial Valve-in-Valve Arm 1-Year Outcomes. JACC Cardiovasc Interv 2021; 14:859-872. [PMID: 33888231 DOI: 10.1016/j.jcin.2021.02.027] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 02/11/2021] [Accepted: 02/16/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVES The aim of this study was to assess 1-year clinical outcomes among high-risk patients with failed surgical mitral bioprostheses who underwent transseptal mitral valve-in-valve (MViV) with the SAPIEN 3 aortic transcatheter heart valve (THV) in the MITRAL (Mitral Implantation of Transcatheter Valves) trial. BACKGROUND The MITRAL trial is the first prospective study evaluating transseptal MViV with the SAPIEN 3 aortic THV in high-risk patients with failed surgical mitral bioprostheses. METHODS High-risk patients with symptomatic moderate to severe or severe mitral regurgitation (MR) or severe mitral stenosis due to failed surgical mitral bioprostheses were prospectively enrolled. The primary safety endpoint was technical success. The primary THV performance endpoint was absence of MR grade ≥2+ or mean mitral valve gradient ≥10 mm Hg (30 days and 1 year). Secondary endpoints included procedural success and all-cause mortality (30 days and 1 year). RESULTS Thirty patients were enrolled between July 2016 and October 2017 (median age 77.5 years [interquartile range (IQR): 70.3 to 82.8 years], 63.3% women, median Society of Thoracic Surgeons score 9.4% [IQR: 5.8% to 12.0%], 80% in New York Heart Association functional class III or IV). The technical success rate was 100%. The primary performance endpoint in survivors was achieved in 96.6% (28 of 29) at 30 days and 82.8% (24 of 29) at 1 year. Thirty-day all-cause mortality was 3.3% and was unchanged at 1 year. The only death was due to airway obstruction after swallowing several pills simultaneously 29 days post-MViV. At 1-year follow-up, 89.3% of patients were in New York Heart Association functional class I or II, the median mean mitral valve gradient was 6.6 mm Hg (interquartile range: 5.5 to 8.9 mm Hg), and all patients had MR grade ≤1+. CONCLUSIONS Transseptal MViV in high-risk patients was associated with 100% technical success, low procedural complication rates, and very low mortality at 1 year. The vast majority of patients experienced significant symptom alleviation, and THV performance remained stable at 1 year.
Collapse
Affiliation(s)
- Mayra Guerrero
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA.
| | - Amit Pursnani
- Division of Cardiology, NorthShore University HealthSystem, Evanston, Illinois, USA
| | - Akhil Narang
- Division of Cardiology, Northwestern Memorial Hospital, Chicago, Illinois, USA
| | - Michael Salinger
- Division of Cardiology, Froedtert Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Dee Dee Wang
- Center for Structural Heart Disease, Henry Ford Hospital, Detroit, Michigan, USA
| | - Mackram Eleid
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Susheel K Kodali
- Division of Cardiology, Columbia University Medical Center, New York, New York, USA
| | - Isaac George
- Department of Surgery, Columbia University Medical Center, New York, New York, USA
| | - Lowell Satler
- Division of Cardiology, Medstar Washington Hospital Center, Washington, DC, USA
| | - Ron Waksman
- Division of Cardiology, Medstar Washington Hospital Center, Washington, DC, USA
| | | | - Vivek Rajagopal
- Division of Cardiology, Piedmont Hospital, Atlanta, Georgia, USA
| | - Ignacio Inglessis
- Division of Cardiology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Igor Palacios
- Division of Cardiology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Mark Reisman
- Division of Cardiology, University of Washington Medical Center, Seattle, Washington, USA
| | - Marvin H Eng
- Center for Structural Heart Disease, Henry Ford Hospital, Detroit, Michigan, USA
| | - Hyde M Russell
- Division of Cardiovascular Surgery, NorthShore University HealthSystem, Evanston, Illinois, USA
| | - Ashish Pershad
- Division of Cardiology, Banner University Medical Center, Phoenix, Arizona, USA
| | - Kenith Fang
- Division of Cardiology, Banner University Medical Center, Phoenix, Arizona, USA
| | - Saibal Kar
- Division of Cardiology, Los Robles Regional Medical Center, Thousand Oaks, California, USA
| | - Rajj Makkar
- Department of Cardiology, Cedars-Sinai Heart Institute, Los Angeles, California, USA
| | - Jorge Saucedo
- Division of Cardiology, Froedtert Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Paul Pearson
- Division of Cardiovascular Surgery, Froedtert Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Ujala Bokhary
- Division of Cardiology, NorthShore University HealthSystem, Evanston, Illinois, USA
| | - Tatiana Kaptzan
- Cardiovascular Research Unit, Mayo Clinic, Rochester, Minnesota, USA
| | - Brad Lewis
- Division of Biostatistics and Informatics, Mayo Clinic, Rochester, Minnesota, USA
| | - Carl Tommaso
- Division of Cardiology, NorthShore University HealthSystem, Evanston, Illinois, USA
| | - Philip Krause
- Division of Cardiology, NorthShore University HealthSystem, Evanston, Illinois, USA
| | - Jeremy Thaden
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Jae Oh
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Roberto M Lang
- Division of Cardiology, University of Chicago Medical Center, Chicago, Illinois, USA
| | - Rebecca T Hahn
- Division of Cardiology, Columbia University Medical Center, New York, New York, USA
| | - Martin B Leon
- Division of Cardiology, Columbia University Medical Center, New York, New York, USA
| | - William W O'Neill
- Center for Structural Heart Disease, Henry Ford Hospital, Detroit, Michigan, USA
| | - Ted Feldman
- Edwards Lifesciences, Irvine, California, USA
| | - Charanjit Rihal
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| |
Collapse
|
7
|
Sengupta A, Yazdchi F, Alexis SL, Percy E, Premkumar A, Hirji S, Bapat VN, Bhatt DL, Kaneko T, Tang GHL. Reoperative Mitral Surgery Versus Transcatheter Mitral Valve Replacement: A Systematic Review. J Am Heart Assoc 2021; 10:e019854. [PMID: 33686870 PMCID: PMC8174229 DOI: 10.1161/jaha.120.019854] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Bioprosthetic mitral structural valve degeneration and failed mitral valve repair (MVr) have traditionally been treated with reoperative mitral valve surgery. Transcatheter mitral valve-in-valve (MVIV) and valve-in-ring (MVIR) replacement are now feasible, but data comparing these approaches are lacking. We sought to compare the outcomes of (1) reoperative mitral valve replacement (redo-MVR) and MVIV for structural valve degeneration, and (2) reoperative mitral valve repair (redo-MVr) or MVR and MVIR for failed MVr. A literature search of PubMed, Embase, and the Cochrane Library was conducted up to July 31, 2020. Thirty-two studies involving 25 832 patients were included. Redo-MVR was required in ≈35% of patients after index surgery at 10 years, with 5% to 15% 30-day mortality. MVIV resulted in >95% procedural success with 30-day and 1-year mortality of 0% to 8% and 11% to 16%, respectively. Recognized complications included left ventricular outflow tract obstruction (0%-6%), valve migration (0%-9%), and residual regurgitation (0%-6%). Comparisons of redo-MVR and MVIV showed no statistically significant differences in mortality (11.3% versus 11.9% at 1 year, P=0.92), albeit higher rates of major bleeding and arrhythmias with redo-MVR. MVIR resulted in 0% to 34% mortality at 1 year, whereas both redo-MVr and MVR for failed repairs were performed with minimal mortality and durable long-term results. MVIV is therefore a viable alternative to redo-MVR for structural valve degeneration, whereas redo-MVr or redo-MVR is preferred for failed MVr given the suboptimal results with MVIR. However, not all patients will be candidates for MVIV/MVIR because anatomical restrictions may preclude transcatheter options from adequately addressing the underlying pathology.
Collapse
Affiliation(s)
- Aditya Sengupta
- Department of Cardiovascular Surgery Mount Sinai Hospital New York NY
| | - Farhang Yazdchi
- Division of Cardiac Surgery Brigham and Women's Hospital Boston MA
| | - Sophia L Alexis
- Department of Cardiovascular Surgery Mount Sinai Hospital New York NY
| | - Edward Percy
- Division of Cardiac Surgery Brigham and Women's Hospital Boston MA
| | - Akash Premkumar
- Division of Cardiac Surgery Brigham and Women's Hospital Boston MA
| | - Sameer Hirji
- Division of Cardiac Surgery Brigham and Women's Hospital Boston MA
| | | | - Deepak L Bhatt
- Brigham and Women's Heart & Vascular CenterHarvard Medical School Boston MA
| | - Tsuyoshi Kaneko
- Division of Cardiac Surgery Brigham and Women's Hospital Boston MA
| | - Gilbert H L Tang
- Department of Cardiovascular Surgery Mount Sinai Hospital New York NY
| |
Collapse
|
8
|
Guerrero M, Vemulapalli S, Xiang Q, Wang DD, Eleid M, Cabalka AK, Sandhu G, Salinger M, Russell H, Greenbaum A, Kodali S, George I, Dvir D, Whisenant B, Russo MJ, Pershad A, Fang K, Coylewright M, Shah P, Babaliaros V, Khan JM, Tommaso C, Saucedo J, Kar S, Makkar R, Mack M, Holmes D, Leon M, Bapat V, Thourani VH, Rihal C, O’Neill W, Feldman T. Thirty-Day Outcomes of Transcatheter Mitral Valve Replacement for Degenerated Mitral Bioprostheses (Valve-in-Valve), Failed Surgical Rings (Valve-in-Ring), and Native Valve With Severe Mitral Annular Calcification (Valve-in-Mitral Annular Calcification) in the United States. Circ Cardiovasc Interv 2020; 13:e008425. [DOI: 10.1161/circinterventions.119.008425] [Citation(s) in RCA: 107] [Impact Index Per Article: 26.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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.
Collapse
Affiliation(s)
- Mayra Guerrero
- Department of Cardiovascular Medicine, Mayo Clinic Hospital, Rochester, MN (M.G., M.E., A.K.C., G.S., D.H., C.R.)
| | | | - Qun Xiang
- Duke Clinical Research Institute, Durham, NC (S.V., Q.X.)
| | - Dee Dee Wang
- Center for Structural Heart Disease, Henry Ford Hospital (D.D.W., W.O.)
| | - Mackram Eleid
- Department of Cardiovascular Medicine, Mayo Clinic Hospital, Rochester, MN (M.G., M.E., A.K.C., G.S., D.H., C.R.)
| | - Allison K. Cabalka
- Department of Cardiovascular Medicine, Mayo Clinic Hospital, Rochester, MN (M.G., M.E., A.K.C., G.S., D.H., C.R.)
| | - Gurpreet Sandhu
- Department of Cardiovascular Medicine, Mayo Clinic Hospital, Rochester, MN (M.G., M.E., A.K.C., G.S., D.H., C.R.)
| | - Michael Salinger
- Division of Cardiology, Froedtert Medical College of Wisconsin, Milwaukee (M.S.)
| | - Hyde Russell
- Division of Cardiovascular Surgery (H.R.), NorthShore University Health System, Evanston, IL
| | - Adam Greenbaum
- Structural Heart and Valve Center, Emory University, Atlanta, GA (A.G., V.B.)
| | | | - Isaac George
- Department of Surgery, Columbia University Medical Center, New York (I.G., V.B.)
| | - Danny Dvir
- Division of Cardiology, University of Washington Medical Center, Seattle (D.D.)
| | - Brian Whisenant
- Division of Cardiology, Intermountain Heart Institute, Salt Lake City, UT (B.W.)
| | - Mark J. Russo
- Department of Surgery, Rutgers Robert Wood Johnson Medical School in New Brunswick, NJ (M.J.R.)
| | - Ashish Pershad
- Division of Cardiology (A.P.), Banner University Medical Center, Phoenix, AZ
| | - Kenith Fang
- Department of Surgery (K.F.), Banner University Medical Center, Phoenix, AZ
| | - Megan Coylewright
- Division of Cardiology, Dartmouth-Hitchcock Medical Center, Lebanon, NH (M.C.)
| | - Pinak Shah
- Division of Cardiology, Brigham and Women’s Hospital, Brighton, MA (P.S.)
| | - Vasilis Babaliaros
- Structural Heart and Valve Center, Emory University, Atlanta, GA (A.G., V.B.)
| | - Jaffar M. Khan
- Cardiovascular and Pulmonary Branch, Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD (J.M.K.)
| | - Carl Tommaso
- Division of Cardiology (C.T., T.F.), NorthShore University Health System, Evanston, IL
| | | | - Saibal Kar
- Division of Cardiology, Cedar’s Sinai Medical Center, Los Angeles, CA (S.K., R.M.)
| | - Rajj Makkar
- Division of Cardiology, Cedar’s Sinai Medical Center, Los Angeles, CA (S.K., R.M.)
| | - Michael Mack
- Department of Surgery, Heart Hospital Baylor Plano, Baylor Healthcare System, TX (M.M.)
| | - David Holmes
- Department of Cardiovascular Medicine, Mayo Clinic Hospital, Rochester, MN (M.G., M.E., A.K.C., G.S., D.H., C.R.)
| | | | - Vinayak Bapat
- Department of Surgery, Columbia University Medical Center, New York (I.G., V.B.)
| | - Vinod H. Thourani
- Department of Cardiovascular Surgery, Marcus Valve Center, Piedmont Heart Institute, Atlanta, GA (V. H.T.)
| | - Charanjit Rihal
- Department of Cardiovascular Medicine, Mayo Clinic Hospital, Rochester, MN (M.G., M.E., A.K.C., G.S., D.H., C.R.)
| | - William O’Neill
- Center for Structural Heart Disease, Henry Ford Hospital (D.D.W., W.O.)
| | - Ted Feldman
- Division of Cardiology (C.T., T.F.), NorthShore University Health System, Evanston, IL
| |
Collapse
|
9
|
Single-institution, 22-year follow-up of 786 CarboMedics mechanical valves used for both primary surgery and reoperation. J Thorac Cardiovasc Surg 2014; 147:1493-8. [DOI: 10.1016/j.jtcvs.2013.05.017] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2013] [Revised: 05/19/2013] [Accepted: 05/31/2013] [Indexed: 11/17/2022]
|
10
|
Gurvitch R, Cheung A, Ye J, Wood DA, Willson AB, Toggweiler S, Binder R, Webb JG. Transcatheter Valve-in-Valve Implantation for Failed Surgical Bioprosthetic Valves. J Am Coll Cardiol 2011; 58:2196-209. [DOI: 10.1016/j.jacc.2011.09.009] [Citation(s) in RCA: 109] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2011] [Revised: 09/12/2011] [Accepted: 09/13/2011] [Indexed: 10/15/2022]
|