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Awtry JA, Shi WY, McGurk S, Louis C, Ailawadi G, George I, Smith RL, Sabe AA, Kaneko T. National trends in utilization of transatrial transcatheter mitral valve replacement and postoperative outcomes. J Thorac Cardiovasc Surg 2023:S0022-5223(23)00966-2. [PMID: 37839658 DOI: 10.1016/j.jtcvs.2023.10.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 09/09/2023] [Accepted: 10/01/2023] [Indexed: 10/17/2023]
Abstract
OBJECTIVE Transatrial transcatheter mitral valve replacement reduces complexity during mitral valve replacements involving high-risk patients with mitral annular calcification. This study examines trends in transatrial transcatheter mitral valve replacement use and outcomes. METHODS Patients in the Society of Thoracic Surgeons database from 2014 to 2021 with mitral annular calcification undergoing transatrial transcatheter mitral valve replacement were included. Exclusion criteria were hypertrophic cardiomyopathy, congenital mitral valve disease, ventricular assist device placement, or prior mitral valve surgery. Primary outcomes were operative mortality and major adverse cardiac events compared between the Early (2014-2017, N = 71) and Recent (2018-2021, N = 151) eras. Parsimonious multivariable regression assessed select possible confounders for trends in major adverse cardiac events. RESULTS Overall, 222 transatrial transcatheter mitral valve replacements at 104 hospitals were identified. Annual volume increased from 6 in 2014 to 43 in 2021. Median hospital volume was 1, maximum hospital volume was 17, and 10 or more replacements were performed at 4 hospitals. Mortality and major adverse cardiac events occurred in 10.4% and 22.5% of patients, respectively. Compared with the Early era patients, Recent era patients were more often elective (79.5% vs 64.8%) and were approached via sternotomy (90.1% vs 80.3%, all P < .05). Despite similar predicted risk of mortality (9.6% ± 11.1% vs 11.0% ± 6.0%; P = .61), Recent patients had reduced mortality (3.3% vs 25.4%, P < .001) and major adverse cardiac events (18.5% vs 31.0%; P = .057). On univariate and multivariable analyses, the Recent surgical era was significantly associated with lower mortality (0.10 [0.04-0.29]; P < .001) and lower major adverse cardiac events (0.48 [0.25-0.94]; P = .032), respectively. There were no preoperative characteristics that were significant confounders for the difference in major adverse cardiac events. CONCLUSIONS Mortality and major adverse cardiac events after transatrial transcatheter mitral valve replacement have decreased significantly in the contemporary era independent of changes in major patient and operative characteristics. Transatrial transcatheter mitral valve replacement will have a future role in patients with mitral annular calcification.
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Affiliation(s)
- Jake A Awtry
- Division of Cardiac Surgery, Brigham and Women's Hospital, Boston, Mass; Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass
| | - William Y Shi
- Division of Cardiovascular and Thoracic Surgery, Northwell Health System, New York, NY
| | - Siobhan McGurk
- Division of Cardiac Surgery, Brigham and Women's Hospital, Boston, Mass
| | - Clauden Louis
- Division of Cardiac Surgery, Brigham and Women's Hospital, Boston, Mass
| | - Gorav Ailawadi
- Division of Cardiac Surgery, University of Michigan, Ann Arbor, Mich
| | - Isaac George
- Division of Cardiac Surgery, New York Presbyterian/Columbia University Medical Center, New York, NY
| | - Robert L Smith
- Department of Cardiothoracic Surgery, Baylor Scott and White, The Heart Hospital, Plano, Tex
| | - Ashraf A Sabe
- Division of Cardiac Surgery, Brigham and Women's Hospital, Boston, Mass.
| | - Tsuyoshi Kaneko
- Division of Cardiothoracic Surgery, Washington University in St Louis/Barnes-Jewish Hospital, St Louis, Mo
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Jain P, Mohammed AN, Fischer C, Aljure O. Current and Investigational Transcatheter Mitral Valve Replacement Systems: A Narrative Review for the Cardiac Anesthesiologist. J Cardiothorac Vasc Anesth 2022; 36:4108-4128. [PMID: 35915003 DOI: 10.1053/j.jvca.2022.05.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 04/21/2022] [Accepted: 05/13/2022] [Indexed: 11/11/2022]
Affiliation(s)
- Pankaj Jain
- Department of Anesthesiology University of Miami Miller School of Medicine, Miami, FL.
| | - Asif Neil Mohammed
- Department of Anesthesiology University of Miami Miller School of Medicine, Miami, FL
| | - Charles Fischer
- Department of Anesthesiology University of Miami Miller School of Medicine, Miami, FL
| | - Oscar Aljure
- Department of Anesthesiology University of Miami Miller School of Medicine, Miami, FL
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Chehab O, Roberts-Thomson R, Bivona A, Gill H, Patterson T, Pursnani A, Grigoryan K, Vargas B, Bokhary U, Blauth C, Lucchese G, Bapat V, Guerrero M, Redwood S, Prendergast B, Rajani R. Management of Patients With Severe Mitral Annular Calcification: JACC State-of-the-Art Review. J Am Coll Cardiol 2022; 80:722-738. [PMID: 35953138 DOI: 10.1016/j.jacc.2022.06.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 06/17/2022] [Accepted: 06/21/2022] [Indexed: 11/28/2022]
Abstract
Mitral annular calcification (MAC) is a common and challenging pathologic condition, especially in the context of an aging society. Surgical mitral valve intervention in patients with MAC is difficult, with varying approaches to the calcified annular anatomy, and the advent of transcatheter valve interventions has provided additional treatment options. Advanced imaging provides the foundation for heart team discussions and management decisions concerning individual patients. This review focuses on the prognosis of, preoperative planning for, and management strategies for patients with MAC.
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Affiliation(s)
- Omar Chehab
- Departments of Cardiology and Cardiac Surgery, St Thomas' Hospital, Westminster Bridge Road, London, United Kingdom
| | - Ross Roberts-Thomson
- Departments of Cardiology and Cardiac Surgery, St Thomas' Hospital, Westminster Bridge Road, London, United Kingdom; Department of Cardiology, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Antonio Bivona
- Departments of Cardiology and Cardiac Surgery, St Thomas' Hospital, Westminster Bridge Road, London, United Kingdom
| | - Harminder Gill
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| | - Tiffany Patterson
- Departments of Cardiology and Cardiac Surgery, St Thomas' Hospital, Westminster Bridge Road, London, United Kingdom; School of Cardiovascular Medicine and Sciences, King's College London, London, United Kingdom
| | - Amit Pursnani
- Division of Cardiology, Evanston Hospital, Northshore University Health System, Evanston, Illinois, USA
| | - Karine Grigoryan
- Departments of Cardiology and Cardiac Surgery, St Thomas' Hospital, Westminster Bridge Road, London, United Kingdom
| | - Bernardo Vargas
- Division of Cardiology, Evanston Hospital, Northshore University Health System, Evanston, Illinois, USA
| | - Ujala Bokhary
- Division of Cardiology, Evanston Hospital, Northshore University Health System, Evanston, Illinois, USA
| | - Christopher Blauth
- Departments of Cardiology and Cardiac Surgery, St Thomas' Hospital, Westminster Bridge Road, London, United Kingdom
| | - Gianluca Lucchese
- Departments of Cardiology and Cardiac Surgery, St Thomas' Hospital, Westminster Bridge Road, London, United Kingdom
| | - Vinayak Bapat
- Center for Valve and Structural Heart Disease, Minneapolis Heart Institute, Minneapolis, Minnesota, USA
| | - Mayra Guerrero
- Department of Cardiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Simon Redwood
- Departments of Cardiology and Cardiac Surgery, St Thomas' Hospital, Westminster Bridge Road, London, United Kingdom; School of Cardiovascular Medicine and Sciences, King's College London, London, United Kingdom
| | - Bernard Prendergast
- Departments of Cardiology and Cardiac Surgery, St Thomas' Hospital, Westminster Bridge Road, London, United Kingdom.
| | - Ronak Rajani
- Departments of Cardiology and Cardiac Surgery, St Thomas' Hospital, Westminster Bridge Road, London, United Kingdom; School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
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