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Transcatheter Aortic Valve Replacement in Patients With Aortic Stenosis and Mitral Regurgitation.

Publication ,  Journal Article
Mavromatis, K; Thourani, VH; Stebbins, A; Vemulapalli, S; Devireddy, C; Guyton, RA; Matsouaka, R; Ghasemzadeh, N; Block, PC; Leshnower, BG ...
Published in: The Annals of thoracic surgery
December 2017

Many patients undergoing transcatheter aortic valve replacement (TAVR) for aortic stenosis also have significant mitral regurgitation (MR). We sought to understand the association of concomitant MR with TAVR clinical outcomes, as well changes in MR after TAVR.Patients who underwent TAVR in the US Transcatheter Valve Therapy Registry from January 3, 2012, to December 31, 2013, were studied, with longer-term clinical outcomes from Center for Medicare Services data.Of 11,104 patients, 3,481 (31.3%) had moderate MR, and 605 (5.5%) had severe MR. At 1 year, mortality was 21.0%, 21.5%, 26.3%, and 28.0% (p < 0.0001) and heart failure (HF) rehospitalization was 13.9%, 15.8%, 20.3%, and 23.4% (p < 0.0001) in the no, mild, moderate, and severe MR patients, respectively. After adjustment for baseline differences, significant MR was associated with increased risk of 1-year mortality or HF rehospitalization, with a HR of 1.16 (95% CI, 0.99 to 1.35) for moderate MR and 1.21 (95% CI, 0.97 to 1.50) for severe MR, compared with no MR. MR improved early after TAVR grade ≥ 1 in 79% of the severe MR patients and 66% of the moderate MR patients. Patients whose baseline moderate or severe MR improved had lower mortality (p = 0.022) and HF rehospitalization (p < 0.001) compared with patients whose MR did not improve.Moderate or severe MR accompanying severe AS treated with TAVR is associated with increased mortality or HF rehospitalization. This increased risk may be attributable to the minority of patients whose MR does not improve, suggesting a potential role for surveillance and targeted intervention for those patients.

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Published In

The Annals of thoracic surgery

DOI

EISSN

1552-6259

ISSN

0003-4975

Publication Date

December 2017

Volume

104

Issue

6

Start / End Page

1977 / 1985

Related Subject Headings

  • United States
  • Treatment Outcome
  • Transcatheter Aortic Valve Replacement
  • Survival Rate
  • Severity of Illness Index
  • Risk Factors
  • Retrospective Studies
  • Respiratory System
  • Postoperative Complications
  • Mitral Valve Insufficiency
 

Citation

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Mavromatis, K., Thourani, V. H., Stebbins, A., Vemulapalli, S., Devireddy, C., Guyton, R. A., … Babaliaros, V. (2017). Transcatheter Aortic Valve Replacement in Patients With Aortic Stenosis and Mitral Regurgitation. The Annals of Thoracic Surgery, 104(6), 1977–1985. https://doi.org/10.1016/j.athoracsur.2017.05.065
Mavromatis, Kreton, Vinod H. Thourani, Amanda Stebbins, Sreekanth Vemulapalli, Chandan Devireddy, Robert A. Guyton, Roland Matsouaka, et al. “Transcatheter Aortic Valve Replacement in Patients With Aortic Stenosis and Mitral Regurgitation.The Annals of Thoracic Surgery 104, no. 6 (December 2017): 1977–85. https://doi.org/10.1016/j.athoracsur.2017.05.065.
Mavromatis K, Thourani VH, Stebbins A, Vemulapalli S, Devireddy C, Guyton RA, et al. Transcatheter Aortic Valve Replacement in Patients With Aortic Stenosis and Mitral Regurgitation. The Annals of thoracic surgery. 2017 Dec;104(6):1977–85.
Mavromatis, Kreton, et al. “Transcatheter Aortic Valve Replacement in Patients With Aortic Stenosis and Mitral Regurgitation.The Annals of Thoracic Surgery, vol. 104, no. 6, Dec. 2017, pp. 1977–85. Epmc, doi:10.1016/j.athoracsur.2017.05.065.
Mavromatis K, Thourani VH, Stebbins A, Vemulapalli S, Devireddy C, Guyton RA, Matsouaka R, Ghasemzadeh N, Block PC, Leshnower BG, Stewart JP, Rumsfeld JS, Lerakis S, Babaliaros V. Transcatheter Aortic Valve Replacement in Patients With Aortic Stenosis and Mitral Regurgitation. The Annals of thoracic surgery. 2017 Dec;104(6):1977–1985.
Journal cover image

Published In

The Annals of thoracic surgery

DOI

EISSN

1552-6259

ISSN

0003-4975

Publication Date

December 2017

Volume

104

Issue

6

Start / End Page

1977 / 1985

Related Subject Headings

  • United States
  • Treatment Outcome
  • Transcatheter Aortic Valve Replacement
  • Survival Rate
  • Severity of Illness Index
  • Risk Factors
  • Retrospective Studies
  • Respiratory System
  • Postoperative Complications
  • Mitral Valve Insufficiency