Comparison of Clinical and Echocardiographic Outcomes After Surgical Redo Mitral Valve Replacement and Transcatheter Mitral Valve-in-Valve Therapy
| Autor: | Gaetano Paone, Michael Morse, John A. Wells, Frank Corrigan, Norihiko Kamioka, Hope Caughron, Marvin H. Eng, Evelio Rodriguez, Bradley G. Leshnower, Robert A. Guyton, William W. O'Neill, Stamatios Lerakis, Jose Miguel Iturbe, Altayyeb Yousef, Vasilis Babaliaros, Peter C. Block, Jose N. Binongo, Andy Dong, Patrick Gleason, Tiberio Frisoli, Adam Greenbaum |
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| Rok vydání: | 2018 |
| Předmět: |
Male
Reoperation medicine.medical_specialty Cardiac Catheterization medicine.medical_treatment Heart Valve Diseases 030204 cardiovascular system & hematology Bioprosthetic valve 03 medical and health sciences 0302 clinical medicine Sts prom Predictive Value of Tests Risk Factors Mitral valve medicine Risk of mortality Humans In patient 030212 general & internal medicine Device Removal Aged Retrospective Studies Aged 80 and over Bioprosthesis Heart Valve Prosthesis Implantation business.industry Significant difference Mitral valve replacement Mean age Recovery of Function Middle Aged United States Surgery Prosthesis Failure medicine.anatomical_structure Treatment Outcome Echocardiography Heart Valve Prosthesis Mitral Valve Female Cardiology and Cardiovascular Medicine business |
| Zdroj: | JACC. Cardiovascular interventions. 11(12) |
| ISSN: | 1876-7605 |
| Popis: | There are minimal data regarding clinical outcomes and echocardiographic findings after transcatheter mitral valve-in-valve replacement (TMVR) compared with redo surgical mitral valve replacement (SMVR).TMVR therapy has emerged as therapy for a degenerated bioprosthetic valve failure.The authors retrospectively identified patients with degenerated mitral bioprostheses who underwent redo SMVR or TMVR at 3 U.S. institutions. The authors compared clinical and echocardiographic outcomes of patients who had TMVR with those of patients who underwent redo SMVR.Sixty-two patients underwent TMVR and 59 patients underwent SMVR during the study period. Mean age and the Society of Thoracic Surgeons Predicted Risk of Mortality (STS PROM) scores were significantly higher in patients with TMVR than in those with SMVR (age 74.9 ± 9.4 years vs. 63.7 ± 14.9 years; p 0.001; STS PROM 12.7 ± 8.0% vs. 8.7 ± 10.1%; p 0.0001). Total procedure time, intensive care unit hours, and post-procedure length of stay were all significantly shorter in the TMVR group. There was no difference in mortality at 1 year between the 2 groups (TMVR 11.3% vs. SMVR 11.9%; p = 0.92). Mean mitral valve pressure gradient and the grade of mitral regurgitation (MR) were similar between the TMVR group and the SMVR group (mitral valve pressure gradient 7.1 ± 2.5 mm Hg vs. 6.5 ± 2.5 mm Hg; p = 0.42; MR [≥moderate] 3.8% vs. 5.6%; p = 1.00) at 30 days. At 1 year, the mitral valve pressure gradient was higher in the TMVR group (TMVR 7.2 ± 2.7 vs. SMVR 5.5 ± 1.8; p = 0.01), although there was no difference in the grade of MR.Despite the higher STS PROM in TMVR patients, there was no difference in 1-year mortality between the TMVR and SMVR groups. Echocardiographic findings after TMVR were similar to SMVR at 30 days. There was a statistically significant difference in mitral gradient at 1 year, though this is likely not clinically important. TMVR may be an alternative to SMVR in patients with previous mitral bioprosthetic valves. |
| Databáze: | OpenAIRE |
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