Early and Midterm Clinical and Hemodynamic Outcomes of Transcatheter Valve-in-Valve Implantation: Results From a Multicenter Experience

D’Onofrio, Augusto; Tarja, Erjon; Besola, Laura; Luzi, Giampaolo; Agrifoglio, Marco; Aiello, Marco; Gabbieri, Davide; Tarantini, Giuseppe; Rizzoli, Giulio; Musumeci, Francesco; Gerosa, Gino

doi:10.1016/j.athoracsur.2016.05.055

Cited by 10 publications

(12 citation statements)

References 24 publications

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“…with twofold increase in mortality [53]. Others have also reported similar outcomes of TAViV [54,55]. In our systematic review, small surgical valve was used in 25% and was similar with the previous report.…”

Section: Discussionsupporting

confidence: 90%

A systematic review of reported cases of combined transcatheter aortic and mitral valve interventions

Ando

Takagi

Briasoulis

et al. 2017

Cathet Cardio Intervent

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Section: Discussionsupporting

confidence: 90%

A systematic review of reported cases of combined transcatheter aortic and mitral valve interventions

Ando

Takagi

Briasoulis

et al. 2017

Cathet Cardio Intervent

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“…The median number of patients per study was 120 (interquartile range 60-292) with median followup of 5 years (interquartile range 5-6 years, mean follow-up 5.6 years). These studies included 23 single-center studies (6,10,) and 8 multi-center studies (39)(40)(41)(42)(43)(44)(45)(46), where 14 were retrospective and 15 had prospective enrolment. The studies were conducted in the UK, Italy, Germany, US, Canada, Spain, Israel, Denmark and Sweden.…”

Section: Resultsmentioning

confidence: 99%

Long term outcomes of transcatheter aortic valve implantation (TAVI): a systematic review of 5-year survival and beyond

Chakos

Wilson-Smith

Arora

et al. 2017

Ann. Cardiothorac. Surg.

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Background: Transcatheter aortic valve implantation/replacement (TAVI/TAVR) is becoming more frequently used to treat aortic stenosis (AS), with increasing push for the procedure in lower risk patients.Numerous randomized controlled trials have demonstrated that TAVI offers a suitable alternative to the current gold standard of surgical aortic valve replacement (SAVR) in terms of short-term outcomes. The present review evaluates long-term outcomes following TAVI procedures.Methods: Literature search using three electronic databases was performed up to June 2017. Studies which included 20 or more patients undergoing TAVI procedures, either as a stand-alone or concomitant procedure and with a follow-up of at least 5 years, were included in the present review. Literature search and data extraction were performed by two independent researchers. Digitized survival data were extracted from Kaplan-Meier curves in order to re-create the original patient data using an iterative algorithm and subsequently aggregated for analysis.Results: Thirty-one studies were included in the present analysis, with a total of 13,857 patients. Two studies were national registries, eight were multi-institutional collaborations and the remainder were institutional series. Overall, 45.7% of patients were male, with mean age of 81.5±7.0 years. Where reported, the mean Logistic EuroSCORE (LES) was 22.1±13.7 and the mean Society of Thoracic Surgeons (STS) score was 9.2±6.6. The pooled analysis found 30-day mortality, cerebrovascular accidents, acute kidney injury (AKI) and requirement for permanent pacemaker (PPM) implantation to be 8.4%, 2.8%, 14.4%, and 13.4%, respectively. Aggregated survival at 1-, 2-, 3-, 5-and 7-year were 83%, 75%, 65%, 48% and 28%, respectively. Conclusions:The present systematic review identified acceptable long-term survival results for TAVI procedures in an elderly population. Extended follow-up is required to assess long-term outcomes following TAVI, particularly before its application is extended into wider population groups. Ann Cardiothorac Surg 2017;6(5):432-443 www.annalscts.com IntroductionAs Western populations age, the prevalence of aortic stenosis (AS) is gradually increasing (1). In a select population, surgical aortic valve replacement (SAVR) is precluded by patient frailty and other comorbidities (2). The availability of transcatheter aortic valve implantation/ replacement (TAVI/TAVR), pioneered in the early 2000s, has made a significant impact on survival for these patients (3-5). These early successes led to a number of trials, such as the PARTNER and US Pivotal trials, which compared TAVI, SAVR and standard treatment outcomes ( Figure 1). As a result, TAVI is increasingly being considered as a less-invasive option for treatment of AS in younger and lower surgical risk patients, where SAVR is not necessarily contraindicated (6,7), although this is not without controversy (8).While the short-term outcomes of TAVI have been well explored, limited studies have examined longer term results (9,10). Additiona...

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“…Such degeneration is often characterized by leaflet thickening, restricted leaflet motion, or flail leaflet and can present as prosthetic mitral stenosis, regurgitation, or a mixed phenotype. In the setting of elevated surgical risk and need for intervention, transseptal transcatheter mitral valve‐in‐ring/−valve replacement (TMVR) has offered a convincing alternative with relatively reduced morbidity, improved recovery, and shorter hospitalizations in selected patients with prosthetic mitral valve stenosis and/or regurgitation …”

Section: Introductionmentioning

confidence: 99%

“…In the setting of elevated surgical risk and need for intervention, transseptal transcatheter mitral valve-in-ring/−valve replacement (TMVR) has offered a convincing alternative with relatively reduced morbidity, improved recovery, and shorter hospitalizations in selected patients with prosthetic mitral valve stenosis and/or regurgitation. [2][3][4][5][6] Although TMVR interventions have become increasingly commonplace, the potentially differing responses of unique patient populations to TMVR have not been elucidated fully. To this end, this study aimed to assess and compare the immediate hemodynamic changes effected by mitral TMVR and the attendant clinical outcomes in patients with mitral valve prostheses that had developed principally either stenotic or regurgitant prosthetic degeneration.…”

Section: Introductionmentioning

confidence: 99%

Hemodynamic and clinical response to transseptal mitral valve‐in‐valve and valve‐in‐ring

Lloyd

Joseph

Cabalka

et al. 2019

Cathet Cardio Intervent

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Objective To understand the clinical and hemodynamic response of patients with stenotic versus regurgitant prosthetic mitral valve degeneration to transseptal transcatheter mitral valve‐in‐ring/‐valve replacement (TMVR). Background Patients with prosthetic mitral valve repair/replacement failure frequently present high‐risk surgical challenges. TMVR has been employed as an alternative to surgery. Methods Forty‐four patients with stenotic/regurgitant degeneration of prior prosthetic mitral annuloplasty and replacement (38) underwent mitral TMVR. Clinical, echocardiographic, and invasive hemodynamic monitoring was conducted at baseline and follow‐up. Results Relative to patients with regurgitant degeneration (28), patients with stenotic degeneration had baseline higher mitral valve gradients (12 ± 4 vs. 7 ± 3 mmHg, p < 0.01) and smaller areas (1.0 ± 0.4 vs. 1.5 ± 0.4 cm2, p = 0.01). TMVR yielded significant reduction in left atrial v‐wave pressures in stenotic and regurgitant cohorts (−7 ± 11, p = 0.03, and −11 ± 12 mmHg, p < 0.01, respectively) and significant, sustained symptomatic improvement. Intracardiac pressures overall, including left ventricular end diastolic pressures, remained elevated. Conclusion Despite baseline differences in valvular disease, TMVR leads to significant hemodynamic and clinical improvement in both stenotic and regurgitant prosthetic mitral valve disease. In both cohorts, TMVR reduced intracardiac pressures to similar postprocedural levels, but pressures remained supranormal. This outcome suggests a multifactorial process defines the pathophysiology of patients undergoing TMVR, including contributions from prosthetic degeneration, changes in left atrial compliance, and diastolic dysfunction, and highlights the need to consider such factors in patient evaluation and treatment.

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Early and Midterm Clinical and Hemodynamic Outcomes of Transcatheter Valve-in-Valve Implantation: Results From a Multicenter Experience

Cited by 10 publications

References 24 publications

A systematic review of reported cases of combined transcatheter aortic and mitral valve interventions

A systematic review of reported cases of combined transcatheter aortic and mitral valve interventions

Long term outcomes of transcatheter aortic valve implantation (TAVI): a systematic review of 5-year survival and beyond

Hemodynamic and clinical response to transseptal mitral valve‐in‐valve and valve‐in‐ring

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