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Impact of preoperative moderate/severe mitral regurgitation on 2-year outcome after transcatheter and surgical aortic valve replacement: insight from the Placement of Aortic Transcatheter Valve (PARTNER) Trial Cohort A.

Publication ,  Journal Article
Barbanti, M; Webb, JG; Hahn, RT; Feldman, T; Boone, RH; Smith, CR; Kodali, S; Zajarias, A; Thompson, CR; Green, P; Babaliaros, V; Makkar, RR ...
Published in: Circulation
December 24, 2013

BACKGROUND: The effect of preoperative mitral regurgitation (MR) on clinical outcomes of patients undergoing transcatheter aortic valve replacement (TAVR) is controversial. This study sought to examine the impact of moderate and severe MR on outcomes after TAVR and surgical aortic valve replacement (SAVR). METHODS AND RESULTS: Data were drawn from the randomized Placement of Aortic Transcatheter Valve (PARTNER) Trial cohort A patients with severe, symptomatic aortic stenosis undergoing either TAVR (n=331) or SAVR (n=299). Both TAVR and SAVR patients were dichotomized according to the degree of preoperative MR (moderate/severe versus none/mild). At baseline, moderate or severe MR was reported in 65 TAVR patients (19.6%) and 63 SAVR patients (21.2%). At 30 days, among survivors who had isolated SAVR/TAVR, moderate/severe MR had improved in 25 SAVR patients (69.4%) and 30 TAVR patients (57.7%), was unchanged in 10 SAVR patients (27.8%) and 19 TAVR patients (36.5%), and worsened in 1 SAVR patient (2.8%) and 4 TAVR patients (5.8%; all P=NS). Mortality at 2 years was higher in SAVR patients with moderate or severe MR than in those with mild or less MR (49.8% versus 28.1%; adjusted hazard ratio, 1.73; 95% confidence interval, 1.01-2.96; P=0.04). In contrast, MR severity at baseline did not affect mortality in TAVR patients (37.0% versus 32.7%, moderate/severe versus none/mild; hazard ratio, 1.14; 95% confidence interval, 0.72-1.78; P=0.58; P for interaction=0.05). CONCLUSIONS: Both TAVR and SAVR were associated with a significant early improvement in MR in survivors. However, moderate or severe MR at baseline was associated with increased 2-year mortality after SAVR but not after TAVR. TAVR may be a reasonable option in selected patients with combined aortic and mitral valve disease. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT00530894.

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Published In

Circulation

DOI

EISSN

1524-4539

Publication Date

December 24, 2013

Volume

128

Issue

25

Start / End Page

2776 / 2784

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Survival Rate
  • Severity of Illness Index
  • Mitral Valve Insufficiency
  • Male
  • Kaplan-Meier Estimate
  • Humans
  • Heart Valve Prosthesis Implantation
  • Heart Valve Prosthesis
  • Follow-Up Studies
 

Citation

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Barbanti, M., Webb, J. G., Hahn, R. T., Feldman, T., Boone, R. H., Smith, C. R., … Placement of Aortic Transcatheter Valve Trial Investigators, . (2013). Impact of preoperative moderate/severe mitral regurgitation on 2-year outcome after transcatheter and surgical aortic valve replacement: insight from the Placement of Aortic Transcatheter Valve (PARTNER) Trial Cohort A. Circulation, 128(25), 2776–2784. https://doi.org/10.1161/CIRCULATIONAHA.113.003885
Barbanti, Marco, John G. Webb, Rebecca T. Hahn, Ted Feldman, Robert H. Boone, Craig R. Smith, Susheel Kodali, et al. “Impact of preoperative moderate/severe mitral regurgitation on 2-year outcome after transcatheter and surgical aortic valve replacement: insight from the Placement of Aortic Transcatheter Valve (PARTNER) Trial Cohort A.Circulation 128, no. 25 (December 24, 2013): 2776–84. https://doi.org/10.1161/CIRCULATIONAHA.113.003885.
Barbanti M, Webb JG, Hahn RT, Feldman T, Boone RH, Smith CR, Kodali S, Zajarias A, Thompson CR, Green P, Babaliaros V, Makkar RR, Szeto WY, Douglas PS, McAndrew T, Hueter I, Miller DC, Leon MB, Placement of Aortic Transcatheter Valve Trial Investigators. Impact of preoperative moderate/severe mitral regurgitation on 2-year outcome after transcatheter and surgical aortic valve replacement: insight from the Placement of Aortic Transcatheter Valve (PARTNER) Trial Cohort A. Circulation. 2013 Dec 24;128(25):2776–2784.

Published In

Circulation

DOI

EISSN

1524-4539

Publication Date

December 24, 2013

Volume

128

Issue

25

Start / End Page

2776 / 2784

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Survival Rate
  • Severity of Illness Index
  • Mitral Valve Insufficiency
  • Male
  • Kaplan-Meier Estimate
  • Humans
  • Heart Valve Prosthesis Implantation
  • Heart Valve Prosthesis
  • Follow-Up Studies