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Transcatheter Aortic Valve Replacement After Prior Mitral Valve Surgery: Results From the Transcatheter Valve Therapy Registry.

Publication ,  Journal Article
Thourani, VH; Kelly, JJ; Cervantes, DG; Vemulapalli, S; Manandhar, P; Forcillo, J; Holmes, DR; Cohen, DJ; Kirtane, AJ; Kodali, SK; Leon, MB ...
Published in: Ann Thorac Surg
June 2020

BACKGROUND: Due to perceived technical challenges, patients with previous surgical mitral valve repair or replacement (SMVR) have been excluded from most transcatheter aortic valve replacement (TAVR) trials. Our objective was to compare the 30-day and 1-year outcomes of TAVR for patients with and without prior SMVR. METHODS: In a retrospective review of The Society of Thoracic Surgeons (STS) and American College of Cardiology (ACC) Transcatheter Valve Therapy (TVT) Registry, we compared 1097 patients with prior SMVR to 46,327 patients without prior SMVR who underwent TAVR between November 2011 and September 2015 at 394 US centers. Preoperative characteristics, procedural details, and clinical outcomes were analyzed. RESULTS: Patients with previous SMVR were younger, more often female, and had higher STS predicted risk of mortality (8.6% vs 6.8%, P < .001). However, there was no difference in 30-day mortality (4.6% vs 5.5%, P = .293), myocardial infarction, stroke, reintervention, new dialysis, or readmission. Moderate/severe paravalvular leak at discharge was also similar (5.8% vs 4.9%, P = .343). At 1 year, morbidity was similar with slightly higher mortality among patients with prior SMVR (20% vs 17.5%, P = .087) that was significant after adjustment (hazard ratio 1.18, P = .043). The type of prior SMVR (repair, bioprosthetic replacement, or mechanical replacement) had no impact on 30-day or 1-year survival. CONCLUSIONS: Patients with prior SMVR undergoing TAVR had similar 30-day outcomes, slightly higher 1-year mortality, and no increase in early paravalvular leak compared with patients who did not have previous SMVR. Prior SMVR should not preclude TAVR for appropriately selected patients.

Duke Scholars

Published In

Ann Thorac Surg

DOI

EISSN

1552-6259

Publication Date

June 2020

Volume

109

Issue

6

Start / End Page

1789 / 1796

Location

Netherlands

Related Subject Headings

  • United States
  • Treatment Outcome
  • Transcatheter Aortic Valve Replacement
  • Survival Rate
  • Risk Factors
  • Retrospective Studies
  • Respiratory System
  • Reoperation
  • Registries
  • Mitral Valve
 

Citation

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MLA
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Thourani, V. H., Kelly, J. J., Cervantes, D. G., Vemulapalli, S., Manandhar, P., Forcillo, J., … Mack, M. J. (2020). Transcatheter Aortic Valve Replacement After Prior Mitral Valve Surgery: Results From the Transcatheter Valve Therapy Registry. Ann Thorac Surg, 109(6), 1789–1796. https://doi.org/10.1016/j.athoracsur.2019.08.113
Thourani, Vinod H., John J. Kelly, David G. Cervantes, Sreekanth Vemulapalli, Pratik Manandhar, Jessica Forcillo, David R. Holmes, et al. “Transcatheter Aortic Valve Replacement After Prior Mitral Valve Surgery: Results From the Transcatheter Valve Therapy Registry.Ann Thorac Surg 109, no. 6 (June 2020): 1789–96. https://doi.org/10.1016/j.athoracsur.2019.08.113.
Thourani VH, Kelly JJ, Cervantes DG, Vemulapalli S, Manandhar P, Forcillo J, et al. Transcatheter Aortic Valve Replacement After Prior Mitral Valve Surgery: Results From the Transcatheter Valve Therapy Registry. Ann Thorac Surg. 2020 Jun;109(6):1789–96.
Thourani, Vinod H., et al. “Transcatheter Aortic Valve Replacement After Prior Mitral Valve Surgery: Results From the Transcatheter Valve Therapy Registry.Ann Thorac Surg, vol. 109, no. 6, June 2020, pp. 1789–96. Pubmed, doi:10.1016/j.athoracsur.2019.08.113.
Thourani VH, Kelly JJ, Cervantes DG, Vemulapalli S, Manandhar P, Forcillo J, Holmes DR, Cohen DJ, Kirtane AJ, Kodali SK, Leon MB, Babaliaros V, Waksman R, Satler LF, Shults CC, Ben-Dor I, Rogers T, Kapadia S, Reardon MJ, Malaisrie SC, Gleason TG, Holper EM, Bavaria JE, Herrmann HC, Szeto WY, Carroll JD, Mack MJ. Transcatheter Aortic Valve Replacement After Prior Mitral Valve Surgery: Results From the Transcatheter Valve Therapy Registry. Ann Thorac Surg. 2020 Jun;109(6):1789–1796.
Journal cover image

Published In

Ann Thorac Surg

DOI

EISSN

1552-6259

Publication Date

June 2020

Volume

109

Issue

6

Start / End Page

1789 / 1796

Location

Netherlands

Related Subject Headings

  • United States
  • Treatment Outcome
  • Transcatheter Aortic Valve Replacement
  • Survival Rate
  • Risk Factors
  • Retrospective Studies
  • Respiratory System
  • Reoperation
  • Registries
  • Mitral Valve