TY - JOUR
T1 - Mitral regurgitation in patients undergoing transcatheter aortic valve implantation for degenerated surgical aortic bioprosthesis
T2 - Insights from PARTNER 2 Valve-in-Valve Registry
AU - Murdoch, Dale J.
AU - Sathananthan, Janarthanan
AU - Hensey, Mark
AU - Alu, Maria C.
AU - Liu, Yangbo
AU - Crowley, Aaron
AU - Wood, David
AU - Cheung, Anson
AU - Ye, Jian
AU - Feldman, Ted
AU - Hahn, Rebecca T.
AU - Jaber, Wael A.
AU - Mack, Michael J.
AU - Malaisrie, S. Chris
AU - Leon, Martin B.
AU - Webb, John G.
N1 - Funding Information:
Dr Murdoch is a consultant and proctor for Edwards Lifesciences. Dr Sathananthan is a consultant to Edwards Lifesciences and Medtronic. Ms. Alu has received consulting fees from Claret Medical and Cardiac Dimensions. Dr. Wood has received research funding and consulting fees from Edwards Lifesciences. Dr. Cheung has received consulting fees from Abbot Vascular, Medtronic, and Neovasc. Dr. Ye has received consulting fees from Edwards Lifesciences and JC Medical. Dr. Feldman has received research funding and consulting fees from Abbott, Boston Scientific, Edwards Lifesciences, and WL Gore, and became an employee of Edwards Lifesciences after this study was completed. Dr. Hahn has received consulting fees or speaking honoraria from 3Mensio, Abbott Vascular, Bayliss, Boston Scientific, Edwards Lifesciences, GE Healthcare, Medtronic, Navigate, Philips, and Siemens Healthineers. Dr. Jaber has echocardiography core lab contracts with Edwards Lifesciences, but receives no direct compensation. Dr. Mack serves on the PARTNER Executive Committee (Edwards, no direct compensation) and as Trial Co‐PI of the COAPT Trial (Abbott, no direct compensation), and has received consulting fees from Gore. Dr. Malaisrie has received consulting fees from Edwards Lifesciences, Medtronic, and Abbott. Dr. Leon serves on the PARTNER Executive Committee (Edwards, no direct compensation) and has participated on medical advisory boards for Medtronic, Boston Scientific, Gore Medical, Meril Lifesciences, and Abbott. Dr. Webb has received research funding from, and is a consultant and proctor for, Edwards Lifesciences. The other authors have no relevant relationships with industry.
PY - 2020/10/1
Y1 - 2020/10/1
N2 - Background: Valve-in-valve (VIV) treatment with transcatheter aortic valve replacement (TAVR) is a viable option for patients with failing aortic bioprosthetic valves. Optimal management of those with concomitant mitral regurgitation (MR) remains undetermined. Therefore, we sought to assess the implications of concomitant MR in patients undergoing VIV-TAVR. Methods and Results: The PARTNER 2 VIV registry enrolled patients with degenerated surgical aortic bioprosthesis at high risk for reoperation. Patients with core-laboratory echocardiographic assessment of MR were analyzed; severe MR was excluded. We compared patients with ≤mild MR versus moderate MR and assessed changes in MR severity and clinical outcomes. A total of 339 patients (89 initial registry, 250 continued access) underwent VIV procedures; mean age 79.0 ± 10.2 years, mean Society of Thoracic Surgeon score 8.9 ± 4.5%. At baseline, 228/339 (67.3%) had ≤mild MR and 111/339 (32.7%) had moderate MR. In paired analysis, there was significant improvement in ≥moderate MR from baseline to 30 days (32.6% vs. 14.5%, p <.0001 [n = 304]), and no significant change between 30 days and 1 year (13.4% vs. 12.1%, p =.56 [n = 224]) or 1 year and 2 years (11.0% vs. 10.4%, p =.81 [n = 182]). There was no difference in death or stroke between ≤mild MR and moderate MR at 30 days (4.0% vs. 7.2%, p =.20), 1 year (15.5% vs. 15.3%, p =.98) or 2 years (26.5% vs. 23.5%, p =.67). Conclusion: Moderate concomitant MR tends to improve with VIV-TAVR, and was not a predictor of long-term adverse outcomes in this cohort. In selected patients undergoing VIV-TAVR, it may be appropriate to conservatively manage concomitant MR. Clinical Trial Registration: ClinicalTrials.gov NCT# 03225001.
AB - Background: Valve-in-valve (VIV) treatment with transcatheter aortic valve replacement (TAVR) is a viable option for patients with failing aortic bioprosthetic valves. Optimal management of those with concomitant mitral regurgitation (MR) remains undetermined. Therefore, we sought to assess the implications of concomitant MR in patients undergoing VIV-TAVR. Methods and Results: The PARTNER 2 VIV registry enrolled patients with degenerated surgical aortic bioprosthesis at high risk for reoperation. Patients with core-laboratory echocardiographic assessment of MR were analyzed; severe MR was excluded. We compared patients with ≤mild MR versus moderate MR and assessed changes in MR severity and clinical outcomes. A total of 339 patients (89 initial registry, 250 continued access) underwent VIV procedures; mean age 79.0 ± 10.2 years, mean Society of Thoracic Surgeon score 8.9 ± 4.5%. At baseline, 228/339 (67.3%) had ≤mild MR and 111/339 (32.7%) had moderate MR. In paired analysis, there was significant improvement in ≥moderate MR from baseline to 30 days (32.6% vs. 14.5%, p <.0001 [n = 304]), and no significant change between 30 days and 1 year (13.4% vs. 12.1%, p =.56 [n = 224]) or 1 year and 2 years (11.0% vs. 10.4%, p =.81 [n = 182]). There was no difference in death or stroke between ≤mild MR and moderate MR at 30 days (4.0% vs. 7.2%, p =.20), 1 year (15.5% vs. 15.3%, p =.98) or 2 years (26.5% vs. 23.5%, p =.67). Conclusion: Moderate concomitant MR tends to improve with VIV-TAVR, and was not a predictor of long-term adverse outcomes in this cohort. In selected patients undergoing VIV-TAVR, it may be appropriate to conservatively manage concomitant MR. Clinical Trial Registration: ClinicalTrials.gov NCT# 03225001.
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U2 - 10.1002/ccd.28811
DO - 10.1002/ccd.28811
M3 - Article
C2 - 32118351
AN - SCOPUS:85081256981
VL - 96
SP - 981
EP - 986
JO - Catheterization and Cardiovascular Interventions
JF - Catheterization and Cardiovascular Interventions
SN - 1522-1946
IS - 4
ER -