Thirty-Day Outcomes of Transcatheter Mitral Valve Replacement for Degenerated Mitral Bioprostheses (Valve-in-Valve), Failed Surgical Rings (Valve-in-Ring), and Native Valve With Severe Mitral Annular Calcification (Valve-in-Mitral Annular Calcification) in the United States: Data From the Society of Thoracic Surgeons/American College of Cardiology/Transcatheter Valve Therapy Registry.

Autor:	Guerrero M; Department of Cardiovascular Medicine, Mayo Clinic Hospital, Rochester, MN (M.G., M.E., A.K.C., G.S., D.H., C.R.)., Vemulapalli S; Duke Clinical Research Institute, Durham, NC (S.V., Q.X.)., Xiang Q; Duke Clinical Research Institute, Durham, NC (S.V., Q.X.)., Wang DD; Center for Structural Heart Disease, Henry Ford Hospital (D.D.W., W.O.)., Eleid M; Department of Cardiovascular Medicine, Mayo Clinic Hospital, Rochester, MN (M.G., M.E., A.K.C., G.S., D.H., C.R.)., Cabalka AK; Department of Cardiovascular Medicine, Mayo Clinic Hospital, Rochester, MN (M.G., M.E., A.K.C., G.S., D.H., C.R.)., Sandhu G; Department of Cardiovascular Medicine, Mayo Clinic Hospital, Rochester, MN (M.G., M.E., A.K.C., G.S., D.H., C.R.)., Salinger M; Division of Cardiology, Froedtert Medical College of Wisconsin, Milwaukee (M.S.)., Russell H; Division of Cardiovascular Surgery (H.R.), NorthShore University Health System, Evanston, IL., Greenbaum A; Structural Heart and Valve Center, Emory University, Atlanta, GA (A.G., V.B.)., Kodali S; Division of Cardiology (S.K., M.L.)., George I; Department of Surgery, Columbia University Medical Center, New York (I.G., V.B.)., Dvir D; Division of Cardiology, University of Washington Medical Center, Seattle (D.D.)., Whisenant B; Division of Cardiology, Intermountain Heart Institute, Salt Lake City, UT (B.W.)., Russo MJ; Department of Surgery, Rutgers Robert Wood Johnson Medical School in New Brunswick, NJ (M.J.R.)., Pershad A; Division of Cardiology (A.P.), Banner University Medical Center, Phoenix, AZ., Fang K; Department of Surgery (K.F.), Banner University Medical Center, Phoenix, AZ., Coylewright M; Division of Cardiology, Dartmouth-Hitchcock Medical Center, Lebanon, NH (M.C.)., Shah P; Division of Cardiology, Brigham and Women's Hospital, Brighton, MA (P.S.)., Babaliaros V; Structural Heart and Valve Center, Emory University, Atlanta, GA (A.G., V.B.)., Khan JM; Cardiovascular and Pulmonary Branch, Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD (J.M.K.)., Tommaso C; Division of Cardiology (C.T., T.F.), NorthShore University Health System, Evanston, IL., Saucedo J, Kar S; Division of Cardiology, Cedar's Sinai Medical Center, Los Angeles, CA (S.K., R.M.)., Makkar R; Division of Cardiology, Cedar's Sinai Medical Center, Los Angeles, CA (S.K., R.M.)., Mack M; Department of Surgery, Heart Hospital Baylor Plano, Baylor Healthcare System, TX (M.M.)., Holmes D; Department of Cardiovascular Medicine, Mayo Clinic Hospital, Rochester, MN (M.G., M.E., A.K.C., G.S., D.H., C.R.)., Leon M; Division of Cardiology (S.K., M.L.)., Bapat V; Department of Surgery, Columbia University Medical Center, New York (I.G., V.B.)., Thourani VH; Department of Cardiovascular Surgery, Marcus Valve Center, Piedmont Heart Institute, Atlanta, GA (V. H.T.)., Rihal C; Department of Cardiovascular Medicine, Mayo Clinic Hospital, Rochester, MN (M.G., M.E., A.K.C., G.S., D.H., C.R.)., O'Neill W; Center for Structural Heart Disease, Henry Ford Hospital (D.D.W., W.O.)., Feldman T; Division of Cardiology (C.T., T.F.), NorthShore University Health System, Evanston, IL.
Jazyk:	angličtina
Zdroj:	Circulation. Cardiovascular interventions [Circ Cardiovasc Interv] 2020 Mar; Vol. 13 (3), pp. e008425. Date of Electronic Publication: 2020 Mar 06.
DOI:	10.1161/CIRCINTERVENTIONS.119.008425
Abstrakt:	Background: Transcatheter mitral valve replacement using aortic transcatheter heart valves has recently become an alternative for patients with degenerated mitral bioprostheses, failed surgical repairs with annuloplasty rings or severe mitral annular calcification who are poor surgical candidates. Outcomes of these procedures are collected in the Society of Thoracic Surgeons/American College of Cardiology/Transcatheter Valve Therapy Registry. A comprehensive analysis of mitral valve-in-valve (MViV), mitral valve-in-ring (MViR), and valve-in-mitral annular calcification (ViMAC) outcomes has not been performed. We sought to evaluate short-term outcomes of early experience with MViV, MViR, and ViMAC in the United States. Methods: Retrospective analysis of data from the Society of Thoracic Surgeons/American College of Cardiology Transcatheter Valve Therapy Registry. Results: Nine hundred three high-risk patients (median Society of Thoracic Surgeons score 10%) underwent MViV (n=680), MViR (n=123), or ViMAC (n=100) between March 2013 and June 2017 at 172 hospitals. Median age was 75 years, 59.2% female. Technical and procedural success were higher in MViV. Left ventricular outflow tract obstruction occurred more frequently with ViMAC (ViMAC=10%, MViR=4.9%, MViV=0.7%; P <0.001). In-hospital mortality (MViV=6.3%, MViR=9%, ViMAC=18%; P =0.004) and 30-day mortality (MViV=8.1%, MViR=11.5%, ViMAC=21.8%; P =0.003) were higher in ViMAC. At 30-day follow-up, median mean mitral valve gradient was 7 mm Hg, most patients (96.7%) had mitral regurgitation grade ≤1 (+) and were in New York Heart Association class I to II (81.7%). Conclusions: MViV using aortic balloon-expandable transcatheter heart valves is associated with a low complication rate, a 30-day mortality lower than predicted by the Society of Thoracic Surgeons score, and superior short-term outcomes than MViR and ViMAC. At 30 days, patients in all groups experienced improvement of symptoms, and valve performance remained stable. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT02245763.
Databáze:	MEDLINE
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