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Ichikawa N, Shiina Y, Koashi Y, Matsumoto Y, Kanie T, Kijima Y, Niinuma H, Abe K. Mitral complex geometric changes aggravate mitral stenosis after transcatheter aortic valve replacement. THE INTERNATIONAL JOURNAL OF CARDIOVASCULAR IMAGING 2024:10.1007/s10554-024-03167-y. [PMID: 38970734 DOI: 10.1007/s10554-024-03167-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/17/2024] [Accepted: 06/22/2024] [Indexed: 07/08/2024]
Abstract
Severe aortic valve stenosis (AS) often coexists with mitral valve stenosis (MS). MS aggravation after transcatheter aortic valve replacement (TAVR) is common, and its etiology is multifactorial. We hypothesized that geometric changes in the mitral complex (mitral valvular and annular deformities) are adjunctive factors aggravating MS after TAVR, particularly in older adults with a smaller left ventricle (LV). This study aimed to evaluate the mitral complex geometric changes before and after TAVR and to assess the important predictors of MS aggravation after TAVR. This retrospective study enrolled consecutive adult patients who underwent TAVR and surgical AVR (SAVR) for severe AS. The mitral valve area (MVA), the angle between the anterior mitral valve leaflet (AMVL) and left ventricular outflow tract (LVOT), AMVL length, mitral annular diameter, presence of mitral annular calcification, and LV size were evaluated using transthoracic echocardiography. This study included 258 patients who underwent TAVR and SAVR. MVA index decreased from 2.3 ± 0.6 cm² to 1.9 ± 0.5 cm² in the TAVR group. The angle between the AMVL and LVOT was 56.3 ± 9.7° preoperatively and increased to 67.3 ± 11.5° after TAVR. In multivariate analysis, the most important predictive factors of MS aggravation after TAVR were a smaller mitral annular diameter, restricted AMVL mobility, and implantation depth (odds ratio: 4.5, 5.3,3.0; 95% confidence interval: 1.6-14, 1.9-17, 1.0-8.9; and p = 0.005, p = 0.001, p = 0.042, respectively). The reduction in MVA after TAVR was related to the restriction of AMVL opening, depth of implantation and narrowing of the mitral annulus.
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Affiliation(s)
- Naoko Ichikawa
- Clinical Laboratory, St. Luke's International Hospital, Tokyo, Japan
| | - Yumi Shiina
- Department of Cardiology, St. Luke's International Hospital, 9-1 Akashi Chuo-ku, Tokyo, 104-8560, Japan.
| | - Yuina Koashi
- Clinical Laboratory, St. Luke's International Hospital, Tokyo, Japan
| | - Yuna Matsumoto
- Clinical Laboratory, St. Luke's International Hospital, Tokyo, Japan
| | - Takayoshi Kanie
- Department of Cardiology, St. Luke's International Hospital, 9-1 Akashi Chuo-ku, Tokyo, 104-8560, Japan
| | - Yasufumi Kijima
- Department of Cardiology, St. Luke's International Hospital, 9-1 Akashi Chuo-ku, Tokyo, 104-8560, Japan
| | - Hiroyuki Niinuma
- Department of Cardiology, St. Luke's International Hospital, 9-1 Akashi Chuo-ku, Tokyo, 104-8560, Japan
| | - Kohei Abe
- Department of Cardiovascular Surgery, St. Luke's International Hospital, Tokyo, Japan
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Demirel C, Winter MP, Nitsche C, Koschatko S, Jantsch C, Mascherbauer K, Halavina K, Heitzinger G, Dona C, Dannenberg V, Spinka G, Koschutnik M, Andreas M, Hengstenberg C, Bartko PE. Mixed aortic valve disease: association with paravalvular leak and reduced survival after transcatheter aortic valve replacement. Eur Heart J Cardiovasc Imaging 2024; 25:718-726. [PMID: 38236149 DOI: 10.1093/ehjci/jeae005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Accepted: 12/29/2023] [Indexed: 01/19/2024] Open
Abstract
AIMS Transcatheter aortic valve replacement (TAVR) revolutionized the therapy of severe aortic stenosis (AS) with rising numbers. Mixed aortic valve disease (MAVD) treated by TAVR is gaining more interest, as those patients represent a more complex cohort as compared with isolated AS. However, concerning long-term outcome for this cohort only, limited data are available. The aim of the study is to assess the prevalence of MAVD in TAVR patients, investigate its association with paravalvular regurgitation (PVR), and analyse its impact on long-term mortality after TAVR. METHODS AND RESULTS We conducted a registry-based cohort study using the Vienna TAVR registry, enrolling patients who underwent TAVR at Medical University of Vienna between January 2007 and May 2020 with available transthoracic echocardiography before and after TAVR (n = 880). Data analysis included PVR incidence and long-term survival outcomes. A total of 647 (73.52%) out of 880 patients had ≥ mild aortic regurgitation next to severe AS. MAVD was associated with PVR compared with isolated AS with an odds ratio of 2.06, 95% confidence interval (CI): 1.51-2.81 (P = <0.001). More than mild PVR after TAVR (n = 168 out of 880: 19.09%) was related to higher mortality compared with the absence of PVR with a hazard ratio (HR) of 1.33, 95% CI: 1.05- 1.67 (P = 0.016). MAVD patients developing ≥ mild PVR after TAVR were also associated with higher mortality compared with the absence of PVR with an HR of 1.30 and 95% CI: 1.04-1.62 (P = 0.022). CONCLUSION MAVD is prevalent among TAVR patients and presents unique challenges, with increased PVR risk and worse outcomes compared with isolated AS. Long-term survival for MAVD patients, not limited to those developing PVR post-TAVR, is compromised. Earlier intervention before the occurrence of structural myocardial damage or surgical valve replacement might be a potential workaround to improve outcomes.
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Affiliation(s)
- Caglayan Demirel
- Department of Internal Medicine II, Clinical Division of Cardiology, Medical University of Vienna, Waehringer Guertel 18-20A, 1090 Vienna, Austria
| | - Max Paul Winter
- Department of Internal Medicine II, Clinical Division of Cardiology, Medical University of Vienna, Waehringer Guertel 18-20A, 1090 Vienna, Austria
| | - Christian Nitsche
- Department of Internal Medicine II, Clinical Division of Cardiology, Medical University of Vienna, Waehringer Guertel 18-20A, 1090 Vienna, Austria
| | - Sophia Koschatko
- Department of Internal Medicine II, Clinical Division of Cardiology, Medical University of Vienna, Waehringer Guertel 18-20A, 1090 Vienna, Austria
| | - Charlotte Jantsch
- Department of Internal Medicine II, Clinical Division of Cardiology, Medical University of Vienna, Waehringer Guertel 18-20A, 1090 Vienna, Austria
| | - Katharina Mascherbauer
- Department of Internal Medicine II, Clinical Division of Cardiology, Medical University of Vienna, Waehringer Guertel 18-20A, 1090 Vienna, Austria
| | - Kseniya Halavina
- Department of Internal Medicine II, Clinical Division of Cardiology, Medical University of Vienna, Waehringer Guertel 18-20A, 1090 Vienna, Austria
| | - Gregor Heitzinger
- Department of Internal Medicine II, Clinical Division of Cardiology, Medical University of Vienna, Waehringer Guertel 18-20A, 1090 Vienna, Austria
| | - Carolina Dona
- Department of Internal Medicine II, Clinical Division of Cardiology, Medical University of Vienna, Waehringer Guertel 18-20A, 1090 Vienna, Austria
| | - Varius Dannenberg
- Department of Internal Medicine II, Clinical Division of Cardiology, Medical University of Vienna, Waehringer Guertel 18-20A, 1090 Vienna, Austria
| | - Georg Spinka
- Department of Internal Medicine II, Clinical Division of Cardiology, Medical University of Vienna, Waehringer Guertel 18-20A, 1090 Vienna, Austria
| | - Matthias Koschutnik
- Department of Internal Medicine II, Clinical Division of Cardiology, Medical University of Vienna, Waehringer Guertel 18-20A, 1090 Vienna, Austria
| | - Martin Andreas
- Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | - Christian Hengstenberg
- Department of Internal Medicine II, Clinical Division of Cardiology, Medical University of Vienna, Waehringer Guertel 18-20A, 1090 Vienna, Austria
| | - Philipp E Bartko
- Department of Internal Medicine II, Clinical Division of Cardiology, Medical University of Vienna, Waehringer Guertel 18-20A, 1090 Vienna, Austria
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Zheng HJ, Liu X, Lin DQ, Cheng YB, Yan CJ, Li J, Cheng W. Clinical impact of baseline mitral regurgitation on outcomes after transcatheter aortic valve replacement for severe aortic stenosis. IJC HEART & VASCULATURE 2024; 50:101348. [PMID: 38322019 PMCID: PMC10844671 DOI: 10.1016/j.ijcha.2024.101348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 01/12/2024] [Accepted: 01/23/2024] [Indexed: 02/08/2024]
Abstract
Objective The clinical impact of baseline mitral regurgitation (MR) on the outcomes after transcatheter aortic valve replacement (TAVR) is not clear. This study sought to assess the clinical impact of baseline MR on outcomes after TAVR. Methods The study was a retrospective analysis. Data was from 120 consecutive patients with severe aortic stenosis (AS) undergoing TAVR at our center from June 2018 and July 2020. Clinical outcomes were assessed at 30-day, 1- and 2-year follow-up. Results The median follow-up was 736.0 (interquartile range, 666.0-965.0) days. Overall survival in patients with nonsignificant and significant baseline MR was not significantly different, while patients from the improved MR group after TAVR demonstrated a significantly higher survival than unchanged or worsened MR group during 2-year follow-up. NYHA functional class had generally improved at 1 year, with only 8.3 % of patients with nonsignificant MR and 17.5 % of patients with significant MR in class III or IV. Patients with improved MR at 1 year after TAVR had a significantly higher LVEF, smaller LVEDD and LVESD than those with unchanged or worsened MR. Among the significant baseline MR group, 70.4 % and 80.0 % of patients had improved to nonsignificant MR at 30-day and 1-year follow-up after TAVR, respectively. Conclusions Significant baseline MR was not associated with the increased risk of all-cause mortality 2 years after TAVR. Significant baseline MR was improved in most patients at 1 year after TAVR. Patients with unchanged or worsened MR had an increased all-cause mortality.
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Affiliation(s)
| | | | - De-Qing Lin
- Department of Cardiac Surgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Yong-Bo Cheng
- Department of Cardiac Surgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Chao-Jun Yan
- Department of Cardiac Surgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Jun Li
- Department of Cardiac Surgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Wei Cheng
- Department of Cardiac Surgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
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Kurpad KP, Haider MZ, Garg N, Katamreddy A, Adoni N, Moussa ID, Mehta SS. Is Concomitant Mitral Stenosis Associated With Worse Outcomes in Patients Who Underwent TAVR? Insights from a National Database. Am J Cardiol 2023; 209:85-88. [PMID: 37871513 DOI: 10.1016/j.amjcard.2023.09.076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 09/12/2023] [Accepted: 09/21/2023] [Indexed: 10/25/2023]
Abstract
Concomitant mitral stenosis (MS) is present in 10% to 15% of all patients who underwent transcatheter aortic valve replacement (TAVR). Our aim is to assess outcomes of TAVR in patients with MS using a national database. The Nationwide Inpatient Sample database was used to identify patients who underwent TAVR from 2015 to 2020. We created 2 groups, patients with and those without MS. We then compared baseline characteristics, demographics, and in-hospital outcomes of the groups. Primary outcomes were in-hospital mortality, acute respiratory failure, and pacemaker placement. Secondary outcomes were length of stay and in-hospital costs. Our study indicates that patients with MS had greater incidence of acute respiratory failure (8.8% vs 4.89%, p = 0.001), complete heart block (13.54% vs 9.36%, p = 0.01), and permanent pacemaker placement (8.03% vs 6.03%, p = 0.05). In-hospital mortality was greater in the MS group; however, it was not statistically significant (1.32% vs 1.53%, p = 0.679).
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Affiliation(s)
- Krishna Prasad Kurpad
- Division of Cardiology, Carle Foundation Hospital, Urbana, Illinois; Department of Medicine, Carle Ilinois College of Medicine, Champaign, Illinois.
| | - Mobeen Zaka Haider
- Division of Cardiology, Carle Foundation Hospital, Urbana, Illinois; Department of Medicine, Carle Ilinois College of Medicine, Champaign, Illinois
| | - Nadish Garg
- Division of Cardiology, University of California Riverside School of Medicine, Riverside, California
| | - Adarsh Katamreddy
- Division of Cardiology, Oregon University Health Sciences, Portland, Oregon
| | - Naveed Adoni
- Division of Cardiology, Carle Foundation Hospital, Urbana, Illinois; Department of Medicine, Carle Ilinois College of Medicine, Champaign, Illinois
| | - Issam D Moussa
- Division of Cardiology, Carle Foundation Hospital, Urbana, Illinois; Department of Medicine, Carle Ilinois College of Medicine, Champaign, Illinois
| | - Sanjay S Mehta
- Division of Cardiology, Carle Foundation Hospital, Urbana, Illinois; Department of Medicine, Carle Ilinois College of Medicine, Champaign, Illinois
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Adjibodou OB, Brinkert M, Haegeli L. Transcatheter Valve Implantation in Patients with Multivalvular Heart Disease. PRAXIS 2023; 112:53-54. [PMID: 36722111 DOI: 10.1024/1661-8157/a003983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Affiliation(s)
| | - Miriam Brinkert
- Department of Cardiology, Cantonal Hospital Aarau, Aarau, Switzerland
| | - Laurent Haegeli
- Department of Cardiology, Cantonal Hospital Aarau, Aarau, Switzerland
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