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Hasan SA, Morsi M, Frakes BS, Bryson ME, Schmidt CW, Seshiah P, Choo J, Smith JM, Answini GA, Stewart-Dehner TL, Yasar SJ, Jollis JG, Berlacher MD, Ratajczak TM, Chung ES, Kereiakes DJ, Garcia S. Management strategies and prognosis of patients ineligible for transcatheter mitral valve replacement. Cardiovasc Revasc Med 2024:S1553-8389(24)00023-X. [PMID: 38355340 DOI: 10.1016/j.carrev.2024.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 01/08/2024] [Accepted: 02/05/2024] [Indexed: 02/16/2024]
Abstract
BACKGROUND Transcatheter mitral valve replacement (TMVR) faces anatomical challenges, currently limiting widespread adoption. OBJECTIVES To describe the natural history and prognosis of patients ineligible for various TMVR devices. METHODS During a 4-year period (2019-2023) 3 TMVR devices (SAPIEN M3, Intrepid and Alta Valve) became available at a single institution (The Christ Hospital, Cincinnati, OH) in the setting of pivotal clinical trials or early feasibility study. Consenting patients who were deemed ineligible ≥1 of these trials were prospectively studied to capture anatomical reasons for ineligibility, cross-over to alternative mitral valve therapies (surgery or high-risk mitral transcatheter edge to edge repair [M-TEER]), and clinical events. RESULTS A total of 61 patients (out of 71 consenting patients or 85.9 %) were deemed ineligible for TMVR during the study period. The mean age was 79.2 ± 8.8 years, 65.6 % were female, with elevated surgical risk (median STS 4.3, IQR: 2.7-7.3). The 2 most common anatomical reasons for ineligibility were increased risk of left ventricular outflow tract obstruction (LVOTO) (n = 24, 39.3 %) and annular size (n = 29, 47.5 %). During follow-up (median 277 [162-555] days) there were 7 deaths (11.5 %) and 12 (19.7 %) hospitalizations for heart failure. Management strategies included high-risk M-TEER in 11 patients (1 death [9.0 %], 0 HF hospitalizations [0 %]), surgery in 9 patients (0 deaths, 1 HF hospitalizations [11.1 %]), and medical management in 41 patients (6 deaths [14.6 %], 11 HF hospitalizations [26.8 %]) (p = 0.715 for mortality and p = 0.093 for HF hospitalizations). Residual MR ≥ moderate was 0 %, 50 %, and 100 % for surgery, M-TEER and medical treatment, respectively (p < 0.001). CONCLUSIONS One third of patients deemed ineligible for TMVR are candidates for high-risk M-TEER or surgery with acceptable morbidity and mortality. Our results have practical implications for patient management.
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Affiliation(s)
- Syeda A Hasan
- The Christ Hospital Heart and Vascular Institute and Lindner Center for Research and Education, Cincinnati, OH, United States of America
| | - Moustafa Morsi
- The Christ Hospital Heart and Vascular Institute and Lindner Center for Research and Education, Cincinnati, OH, United States of America
| | - Belinda S Frakes
- Lindner Center for Research and Education, Cincinnati, OH, United States of America
| | - Marien E Bryson
- Lindner Center for Research and Education, Cincinnati, OH, United States of America
| | - Christian W Schmidt
- The Christ Hospital Heart and Vascular Institute and Lindner Center for Research and Education, Cincinnati, OH, United States of America
| | - Puvi Seshiah
- The Christ Hospital Heart and Vascular Institute and Lindner Center for Research and Education, Cincinnati, OH, United States of America
| | - Joseph Choo
- The Christ Hospital Heart and Vascular Institute and Lindner Center for Research and Education, Cincinnati, OH, United States of America
| | - J Michael Smith
- The Christ Hospital Heart and Vascular Institute and Lindner Center for Research and Education, Cincinnati, OH, United States of America
| | - Geoffrey A Answini
- The Christ Hospital Heart and Vascular Institute and Lindner Center for Research and Education, Cincinnati, OH, United States of America
| | - Terri L Stewart-Dehner
- The Christ Hospital Heart and Vascular Institute and Lindner Center for Research and Education, Cincinnati, OH, United States of America
| | - Senan J Yasar
- The Christ Hospital Heart and Vascular Institute and Lindner Center for Research and Education, Cincinnati, OH, United States of America
| | - James G Jollis
- The Christ Hospital Heart and Vascular Institute and Lindner Center for Research and Education, Cincinnati, OH, United States of America
| | - Mark D Berlacher
- The Christ Hospital Heart and Vascular Institute and Lindner Center for Research and Education, Cincinnati, OH, United States of America
| | - Teresa M Ratajczak
- The Christ Hospital Heart and Vascular Institute and Lindner Center for Research and Education, Cincinnati, OH, United States of America
| | - Eugene S Chung
- The Christ Hospital Heart and Vascular Institute and Lindner Center for Research and Education, Cincinnati, OH, United States of America
| | - Dean J Kereiakes
- The Christ Hospital Heart and Vascular Institute and Lindner Center for Research and Education, Cincinnati, OH, United States of America
| | - Santiago Garcia
- The Christ Hospital Heart and Vascular Institute and Lindner Center for Research and Education, Cincinnati, OH, United States of America.
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Berlacher MD, Vieth JA, Heflin BC, Gay SR, Antczak AJ, Tasma BE, Boardman HJ, Singh N, Montel AH, Kahaleh MB, Worth RG. FcγRIIa Ligation Induces Platelet Hypersensitivity to Thrombotic Stimuli. The American Journal of Pathology 2013; 182:244-54. [DOI: 10.1016/j.ajpath.2012.09.005] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/22/2012] [Revised: 09/07/2012] [Accepted: 09/13/2012] [Indexed: 01/18/2023]
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