Transcatheter Aortic Valve Replacement in Patients With Multivalvular Heart Disease

Khan, Faisal; Okuno, Taishi; Malebranche, Daniel; Lanz, Jonas; Praz, Fabien; Stortecky, Stefan; Windecker, Stephan; Pilgrim, Thomas

doi:10.1016/j.jcin.2020.03.052

Cited by 53 publications

(52 citation statements)

References 74 publications

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“…In patients undergoing SAVR, degenerative severe MR, preserved LV function, presence of atrial fibrillation, and/or pulmonary hypertension also might be important determinants for concomitant mitral surgery. 26 The current study results might have implications for the indications of mitral valve surgery at time of SAVR in patients with severe AS and concomitant MR. This subgroup analysis included a small number of patients, and thus we could not make adjusted comparison between those with and without MV surgery.…”

Section: Discussionmentioning

confidence: 75%

Concomitant Mitral Regurgitation in Severe Aortic Stenosis　― A Report From the CURRENT AS Registry ―

Murai

Kawase

Taniguchi

et al. 2022

Circ J

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AHA) guidelines, concomitant mitral valve repair or replacement is recommended for patients with severe primary MR (Class I) and mitral valve repair is described as a reasonable option for M itral regurgitation (MR) often coexists with severe aortic stenosis (AS). 1,2 The prevalence of concomitant moderate or severe MR has been reported in 13% 3 to 33% 4 of patients undergoing surgical aortic valve replacement (SAVR) and in 20-30% of patients undergoing transcatheter aortic valve replacement (TAVR). 2 In the current American College of Cardiology Editorial p ????

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Section: Discussionmentioning

confidence: 75%

Concomitant Mitral Regurgitation in Severe Aortic Stenosis　― A Report From the CURRENT AS Registry ―

Murai

Kawase

Taniguchi

et al. 2022

Circ J

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“…During the follow-up post-TAVI, new-onset of MR was reported in discharge diagnosis in 1632 patients (4.2%), meanwhile, 416 patients (0.91%) had new onset of TR. During the follow-up, the yearly incident all-cause mortality rate was 16 S2) Likewise, the S2) Likewise, the yearly incidence and risks of cardiovascular mortality and rehospitalization for heart failure were significantly higher in TAVI patients with MR than those without. No difference was observed in the incidence and risk of stroke between the two groups (Table S2).…”

Section: Resultsmentioning

confidence: 95%

“…Although no significant impact of MR on post-TAVI survival was reported in smaller cohorts [11,12], a meta-analysis demonstrated that significant MR was associated with increased 30-day (pooled odds ratio OR: 1.49, 95% confidence interval CI: 1.16-1.92) and 1-year mortality (pooled hazard ratio HR: 1.32, 95%CI: 1.12-1.55) [13]. Concomitant tricuspid regurgitation (TR), however, is less prevalent than MR in TAVI population, and majority of significant TR are secondary to pulmonary hypertension and right ventricle remodeling [12,[14][15][16]. Baseline moderate to severe TR and right ventricular dysfunction are associated with increased all-cause mortality post TAVI [17].…”

Section: Introductionmentioning

confidence: 99%

The Prognosis of Baseline Mitral Regurgitation in Patients with Transcatheter Aortic Valve Implantation

Zhang

Bisson

Boumhidi

et al. 2021

JCM

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Mitral regurgitation (MR) is the most common valvular lesion in transcatheter aortic valve implantation (TAVI) recipients. This study aims to assess the long-term prognostic impact of baseline MR in TAVI patients. Methods: Adult patients who underwent TAVI were identified in the French National Hospital Discharge Database. All-cause and cardiovascular mortality, stroke, and rehospitalization with heart failure (HF) were compared in TAVI patients with and without baseline MR and tricuspid regurgitation (TR), respectively; the associations of MR and TR with the outcomes were assessed by Cox regression. Results: Baseline MR was identified in 8240 TAVI patients. Patients with baseline MR have higher yearly incidence of all-cause mortality (HR: 1.192, 95% confidence interval CI: 1.125–1.263), cardiovascular mortality (HR: 1.313, 95%CI: 1.210–1.425), and rehospitalization for heart failure (HF) (HR: 1.411, 95%CI: 1.340–1.486) compared to those without, except for stroke rate (HR: 0.988, 95%CI: 0.868–1.124). Neither baseline MR nor TR was an independent risk predictor for all-cause mortality or cardiovascular mortality in TAVI patients. Baseline MR was independently associated with rehospitalization for HF in TAVI patients. Conclusions: Baseline MR and TR were associated with increased all-cause and cardiovascular mortality post-TAVI, however, neither of them was independent predictor for all-cause or cardiovascular mortality.

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“…Transcatheter mitral valve replacement or repair (TMVR/r) at a later date may be an option for these patients, but the outcome is likely to be suboptimal if the valve cannot be surgically repaired [ 67 ]. When a patient’s surgical risk is high or prohibitive, a staged procedure with TAVR, possibly followed by TMVR/r for patients whose MR did not regress, appears appealing [ 68 ]. However, the persistence of severe MR requires cautious clinical reassessment.…”

Section: Decision-making and The Role Of Heart Teammentioning

confidence: 99%

The Common Combination of Aortic Stenosis with Mitral Regurgitation: Diagnostic Insight and Therapeutic Implications in the Modern Era of Advanced Echocardiography and Percutaneous Intervention

Mantovani

Barbieri

Albini

et al. 2021

JCM

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The combination of aortic stenosis (AS) and mitral regurgitation (MR) is common in patients with degenerative valvular disease. It is characterized by having complex pathophysiology, leading to potential diagnostic pitfalls. Evidence is scarce in the literature to direct the diagnostic framework and treatment of patients with this particular combination of multiple valvular diseases. In this complex scenario, the appropriate use of advanced echocardiography and multimodality imaging methods plays a central role. Transcatheter mitral valve replacement or repair and transcatheter aortic valve replacement widen the surgical options for valve diseases. Therefore, there is an increasing need to reconsider the function, timing, and mode intervention for patients with a combination of AS with MR towards more personalized treatment.

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Transcatheter Aortic Valve Replacement in Patients With Multivalvular Heart Disease

Cited by 53 publications

References 74 publications

Concomitant Mitral Regurgitation in Severe Aortic Stenosis　― A Report From the CURRENT AS Registry ―

Concomitant Mitral Regurgitation in Severe Aortic Stenosis　― A Report From the CURRENT AS Registry ―

The Prognosis of Baseline Mitral Regurgitation in Patients with Transcatheter Aortic Valve Implantation

The Common Combination of Aortic Stenosis with Mitral Regurgitation: Diagnostic Insight and Therapeutic Implications in the Modern Era of Advanced Echocardiography and Percutaneous Intervention

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Transcatheter Aortic Valve Replacement in Patients With Multivalvular Heart Disease

Cited by 53 publications

References 74 publications

Concomitant Mitral Regurgitation in Severe Aortic Stenosis ― A Report From the CURRENT AS Registry ―

Concomitant Mitral Regurgitation in Severe Aortic Stenosis ― A Report From the CURRENT AS Registry ―

The Prognosis of Baseline Mitral Regurgitation in Patients with Transcatheter Aortic Valve Implantation

The Common Combination of Aortic Stenosis with Mitral Regurgitation: Diagnostic Insight and Therapeutic Implications in the Modern Era of Advanced Echocardiography and Percutaneous Intervention

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Product

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Concomitant Mitral Regurgitation in Severe Aortic Stenosis　― A Report From the CURRENT AS Registry ―

Concomitant Mitral Regurgitation in Severe Aortic Stenosis　― A Report From the CURRENT AS Registry ―