Transcatheter Treatment of Residual Significant Mitral Regurgitation Following TAVR: A Multicenter Registry.

Autor:	Witberg G; Department of Cardiology, Rabin Medical Centre, Petach-Tikva, Israel; Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel. Electronic address: vitberguy@gmail.com., Codner P; Department of Cardiology, Rabin Medical Centre, Petach-Tikva, Israel; Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel., Landes U; Department of Cardiology, Rabin Medical Centre, Petach-Tikva, Israel; Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel; St. Paul's Hospital, Vancouver, British Columbia, Canada., Barbanti M; Division of Cardiology, University of Catania, Catania, Italy., Valvo R; Division of Cardiology, University of Catania, Catania, Italy., De Backer O; The Heart Center, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark., Ooms JF; Department of Cardiology, Thoraxcenter, Erasmus University Medical Center, Rotterdam, the Netherlands., Sievert K; Cardiovascular Center Frankfurt, Frankfurt, Germany., El Sabbagh A; Department of Cardiovascular Medicine, Mayo Clinic Hospital, Rochester, Minnesota, USA., Jimenez-Quevedo P; Cardiovascular Institute. Hospital Clinico San Carlos, IdISSC, Madrid, Spain., Brennan PF; Department of Cardiology, Royal Victoria Hospital, Belfast Health & Social Care Trust, Belfast, United Kingdom., Sedaghat A; Herzzentrum Bonn Universitätsklinikum Bonn, Bonn, Germany., Masiero G; Department of Cardiac, Thoracic and Vascular Sciences, University of Padua Medical School, Padua, Italy., Werner P; Division of Cardiac Surgery Medical University of Vienna, Vienna, Austria., Overtchouk P; Department of Medicine, Division of Cardiology, McGill University Health Centre, Royal Victoria Hospital, Montreal, Quebec, Canada., Watanabe Y; Department of Cardiology, Teikyo University School of Medicine, Tokyo, Japan., Montorfano M; Department of Interventional Cardiology, San Raffaele Scientific Institute, Milan Italy., Bijjam VR; Department of Cardiology, University Hospital, and National University of Ireland Galway, Galway, Ireland., Hein M; Department of Cardiology and Angiology II, University Heart Center Freiburg-Bad Krozingen, Bad Krozingen, Germany., Fiorina C; Cardiovascular Department, Spedali Civili, Brescia, Italy., Arzamendi D; Hospital de Sant Creu i Sant Pau Barcelona, Barcelona, Spain., Rodriguez-Gabella T; CIBERCV, Hospital Clínico Universitario de Valladolid, Valladolid, Spain., Fernández-Vázquez F; Department of Cardiology, University Hospital of León, León, Spain., Baz JA; Servicio de Cardiología, Hospital Álvaro Cunqueiro, Vigo, Pontevedra, Spain., Laperche C; Department of Interventional Cardiology, Clinique Pasteur, Toulouse, France., Grasso C; Division of Cardiology, University of Catania, Catania, Italy., Branca L; Cardiovascular Department, Spedali Civili, Brescia, Italy., Estévez-Loureiro R; Servicio de Cardiología, Hospital Álvaro Cunqueiro, Vigo, Pontevedra, Spain., Benito-González T; Department of Cardiology, University Hospital of León, León, Spain., Amat Santos IJ; CIBERCV, Hospital Clínico Universitario de Valladolid, Valladolid, Spain., Ruile P; Department of Cardiology and Angiology II, University Heart Center Freiburg-Bad Krozingen, Bad Krozingen, Germany., Mylotte D; Department of Cardiology, University Hospital, and National University of Ireland Galway, Galway, Ireland., Buzzatti N; Department of Interventional Cardiology, San Raffaele Scientific Institute, Milan Italy., Piazza N; Department of Medicine, Division of Cardiology, McGill University Health Centre, Royal Victoria Hospital, Montreal, Quebec, Canada., Andreas M; Division of Cardiac Surgery Medical University of Vienna, Vienna, Austria., Tarantini G; Department of Cardiac, Thoracic and Vascular Sciences, University of Padua Medical School, Padua, Italy., Sinning JM; Herzzentrum Bonn Universitätsklinikum Bonn, Bonn, Germany., Spence MS; Department of Cardiology, Royal Victoria Hospital, Belfast Health & Social Care Trust, Belfast, United Kingdom., Nombela-Franco L; Cardiovascular Institute. Hospital Clinico San Carlos, IdISSC, Madrid, Spain., Guerrero M; Department of Cardiovascular Medicine, Mayo Clinic Hospital, Rochester, Minnesota, USA., Sievert H; Cardiovascular Center Frankfurt, Frankfurt, Germany; Anglia Ruskin University, Chelmsford, United Kingdom; University of California San Francisco, San Francisco, California, USA; Yunnan Hospital Fuwai, Kunming, China., Sondergaard L; The Heart Center, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark., Van Mieghem NM; Department of Cardiology, Thoraxcenter, Erasmus University Medical Center, Rotterdam, the Netherlands., Tchetche D; Department of Interventional Cardiology, Clinique Pasteur, Toulouse, France., Webb JG; Centre for Heart Valve Innovation, St. Paul's Hospital, Vancouver, British Columbia, Canada., Kornowski R; Department of Cardiology, Rabin Medical Centre, Petach-Tikva, Israel; Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
Jazyk:	angličtina
Zdroj:	JACC. Cardiovascular interventions [JACC Cardiovasc Interv] 2020 Dec 14; Vol. 13 (23), pp. 2782-2791.
DOI:	10.1016/j.jcin.2020.07.014
Abstrakt:	Objectives: The aim of this study was to describe baseline characteristics, and periprocedural and mid-term outcomes of patients undergoing transcatheter mitral valve interventions post-transcatheter aortic valve replacement (TAVR) and examine their clinical benefit. Background: The optimal management of residual mitral regurgitation (MR) post-TAVR is challenging. Methods: This was an international registry of 23 TAVR centers. Results: In total, 106 of 24,178 patients (0.43%) underwent mitral interventions post-TAVR (100 staged, 6 concomitant), most commonly percutaneous edge-to-edge mitral valve repair (PMVR). The median interval post-TAVR was 164 days. Mean age was 79.5 ± 7.2 years, MR was >moderate in 97.2%, technical success was 99.1%, and 30-day device success rate was 88.7%. There were 18 periprocedural complications (16.9%) including 4 deaths. During a median follow-up of 464 days, the cumulative risk for 3-year mortality was 29.0%. MR grade and New York Heart Association (NYHA) functional class improved dramatically; at 1 year, MR was moderate or less in 90.9% of patients (mild or less in 69.1%), and 85.9% of patients were in NYHA functional class I/II. Staged PMVR was associated with lower mortality versus medical treatment (57.5% vs. 30.8%) in a propensity-matched cohort (n = 156), but this was not statistically significant (hazard ratio: 1.75; p = 0.05). Conclusions: For patients who continue to have significant MR, remain symptomatic post-TAVR, and are anatomically suitable for transcatheter interventions, these interventions are feasible, safe, and associated with significant improvement in MR grade and NYHA functional class. These results apply mainly to PMVR. A staged PMVR strategy was associated with markedly lower mortality, but this was not statistically significant. (Transcatheter Treatment for Combined Aortic and Mitral Valve Disease. The Aortic+Mitral TRAnsCatheter Valve Registry [AMTRAC]; NCT04031274). Competing Interests: Author Disclosures Dr. Barbanti has received consultant fees from Edwards Lifesciences. Dr. De Backer has received research grants and consultant fees from Abbott and Boston Scientific. Dr. Sievert has received institutional honoraria, travel expenses, and consulting fees from 4tech Cardio, Abbott, Ablative Solutions, Ancora Heart, Append Medical, Bavaria Medizin Technologie GmbH, Bioventrix, Boston Scientific, Carag, CardiacDimensions, Cardimed, Celonova, Comed B.V., Contego, CVRx, Dinova, Edwards Lifesciences, Endologix, Hemoteq, Hangzhou Nuomao Medtech, Holistick Medical, Lifetech, Maquet Getinge Group, Medtronic, Mokita, Occlutech, Recor, RenalGuard, Terumo, Vascular Dynamics, Vectorious Medtech, Venus, Venock, and Vivasure Medical. Dr. Grasso has been a proctor for Abbott Vascular. Dr. Andreas has been a proctor for Abbott and Edwards Lifesciences; and has received advisory board fees from Medtronic. Dr. Guerrero has received research grant support from Edwards Lifesciences. Dr. Van Mieghem has received research grant support from Abbott, Boston Scientific, Edwards Lifesciences, Medtronic, PulseCath BV, and Daiichi-Sankyo; and advisory fees from Abbott, Boston Scientific, Ancora, Medtronic, PulseCath BV, and Daiichi-Sankyo. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. (Copyright © 2020 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.)
Databáze:	MEDLINE
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