Abstract
Background: The risk of surgical mitral valve replacement in patients with severe mitral annular calcification (MAC) is high. Several patients worldwide with severe MAC have been treated successfully with transcatheter mitral valve replacement (TMVR) using balloon-expandable aortic transcatheter valves. The TMVR in MAC Global Registry is a multicenter registry that collects data on outcomes of these procedures. Objectives: The goal of this study was to evaluate 1-year outcomes in this registry. Methods: This study was a multicenter retrospective review of clinical outcomes. Results: A total of 116 extreme surgical risk patients with severe MAC underwent TMVR; 106 had a procedure date >1 year before data-lock and were included in the analysis. Their mean age was 73 ± 12 years, and 68% were female. The mean Society of Thoracic Surgeons score was 15.3 ± 11.6%, and 90% were in New York Heart Association functional class III or IV. Thirty-day and 1-year all-cause mortality was 25% and 53.7%, respectively. Most patients who survived 30 days were alive at 1 year (49 of 77 [63.6%]), and the majority (71.8%) were in New York Heart Association functional class I or II. Echocardiography data at 1 year were available in 34 patients. Mean left ventricular ejection fraction was 58.6 ± 11.2%, mean mitral valve area was 1.9 ± 0.5 cm2, mean mitral gradient was 5.8 ± 2.2 mm Hg, and 75% had zero or trace mitral regurgitation. Conclusions: TMVR with balloon-expandable aortic valves in extreme surgical risk patients with severe MAC is feasible but associated with high 30-day and 1-year mortality. Most patients who survive the 30-day post-procedural period are alive at 1 year and have sustained improvement of symptoms and transcatheter valve performance. The role of TMVR in patients with MAC requires further evaluation in clinical trials.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 1841-1853 |
| Number of pages | 13 |
| Journal | Journal of the American College of Cardiology |
| Volume | 71 |
| Issue number | 17 |
| DOIs | |
| State | Published - May 1 2018 |
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Keywords
- calcific mitral valve stenosis
- mitral annular calcification
- mitral valve disease
- mitral valve replacement
- transcatheter valve replacement
ASJC Scopus subject areas
- Cardiology and Cardiovascular Medicine
Cite this
1-Year Outcomes of Transcatheter Mitral Valve Replacement in Patients With Severe Mitral Annular Calcification. / Guerrero, Mayra; Urena, Marina; Himbert, Dominique; Wang, Dee Dee; Eleid, Mackram; Kodali, Susheel; George, Isaac; Chakravarty, Tarun; Mathur, Moses; Holzhey, David; Pershad, Ashish; Fang, H. Kenith; O'Hair, Daniel; Jones, Noah; Mahadevan, Vaikom S.; Dumonteil, Nicolas; Rodés-Cabau, Josep; Piazza, Nicolo; Ferrari, Enrico; Ciaburri, Daniel; Nejjari, Mohammed; DeLago, Augustin; Sorajja, Paul; Zahr, Firas; Rajagopal, Vivek; Whisenant, Brian; Shah, Pinak Bipin; Sinning, Jan Malte; Witkowski, Adam; Eltchaninoff, Helene; Dvir, Danny; Martin, Bena; Attizzani, Guilherme F.; Gaia, Diego; Nunes, Nagela S.V.; Fassa, Amir Ali; Kerendi, Faraz; Pavlides, Gregory; Iyer, Vijay; Kaddissi, Georges; Witzke, Christian; Wudel, James; Mishkel, Gregory; Raybuck, Bryan; Wang, Chi; Waksman, Ron; Palacios, Igor; Cribier, Alain; Webb, John; Bapat, Vinnie; Reisman, Mark; Makkar, Raj; Leon, Martin; Rihal, Charanjit; Vahanian, Alec; O'Neill, William; Feldman, Ted.
In: Journal of the American College of Cardiology, Vol. 71, No. 17, 01.05.2018, p. 1841-1853.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - 1-Year Outcomes of Transcatheter Mitral Valve Replacement in Patients With Severe Mitral Annular Calcification
AU - Guerrero, Mayra
AU - Urena, Marina
AU - Himbert, Dominique
AU - Wang, Dee Dee
AU - Eleid, Mackram
AU - Kodali, Susheel
AU - George, Isaac
AU - Chakravarty, Tarun
AU - Mathur, Moses
AU - Holzhey, David
AU - Pershad, Ashish
AU - Fang, H. Kenith
AU - O'Hair, Daniel
AU - Jones, Noah
AU - Mahadevan, Vaikom S.
AU - Dumonteil, Nicolas
AU - Rodés-Cabau, Josep
AU - Piazza, Nicolo
AU - Ferrari, Enrico
AU - Ciaburri, Daniel
AU - Nejjari, Mohammed
AU - DeLago, Augustin
AU - Sorajja, Paul
AU - Zahr, Firas
AU - Rajagopal, Vivek
AU - Whisenant, Brian
AU - Shah, Pinak Bipin
AU - Sinning, Jan Malte
AU - Witkowski, Adam
AU - Eltchaninoff, Helene
AU - Dvir, Danny
AU - Martin, Bena
AU - Attizzani, Guilherme F.
AU - Gaia, Diego
AU - Nunes, Nagela S.V.
AU - Fassa, Amir Ali
AU - Kerendi, Faraz
AU - Pavlides, Gregory
AU - Iyer, Vijay
AU - Kaddissi, Georges
AU - Witzke, Christian
AU - Wudel, James
AU - Mishkel, Gregory
AU - Raybuck, Bryan
AU - Wang, Chi
AU - Waksman, Ron
AU - Palacios, Igor
AU - Cribier, Alain
AU - Webb, John
AU - Bapat, Vinnie
AU - Reisman, Mark
AU - Makkar, Raj
AU - Leon, Martin
AU - Rihal, Charanjit
AU - Vahanian, Alec
AU - O'Neill, William
AU - Feldman, Ted
PY - 2018/5/1
Y1 - 2018/5/1
N2 - Background: The risk of surgical mitral valve replacement in patients with severe mitral annular calcification (MAC) is high. Several patients worldwide with severe MAC have been treated successfully with transcatheter mitral valve replacement (TMVR) using balloon-expandable aortic transcatheter valves. The TMVR in MAC Global Registry is a multicenter registry that collects data on outcomes of these procedures. Objectives: The goal of this study was to evaluate 1-year outcomes in this registry. Methods: This study was a multicenter retrospective review of clinical outcomes. Results: A total of 116 extreme surgical risk patients with severe MAC underwent TMVR; 106 had a procedure date >1 year before data-lock and were included in the analysis. Their mean age was 73 ± 12 years, and 68% were female. The mean Society of Thoracic Surgeons score was 15.3 ± 11.6%, and 90% were in New York Heart Association functional class III or IV. Thirty-day and 1-year all-cause mortality was 25% and 53.7%, respectively. Most patients who survived 30 days were alive at 1 year (49 of 77 [63.6%]), and the majority (71.8%) were in New York Heart Association functional class I or II. Echocardiography data at 1 year were available in 34 patients. Mean left ventricular ejection fraction was 58.6 ± 11.2%, mean mitral valve area was 1.9 ± 0.5 cm2, mean mitral gradient was 5.8 ± 2.2 mm Hg, and 75% had zero or trace mitral regurgitation. Conclusions: TMVR with balloon-expandable aortic valves in extreme surgical risk patients with severe MAC is feasible but associated with high 30-day and 1-year mortality. Most patients who survive the 30-day post-procedural period are alive at 1 year and have sustained improvement of symptoms and transcatheter valve performance. The role of TMVR in patients with MAC requires further evaluation in clinical trials.
AB - Background: The risk of surgical mitral valve replacement in patients with severe mitral annular calcification (MAC) is high. Several patients worldwide with severe MAC have been treated successfully with transcatheter mitral valve replacement (TMVR) using balloon-expandable aortic transcatheter valves. The TMVR in MAC Global Registry is a multicenter registry that collects data on outcomes of these procedures. Objectives: The goal of this study was to evaluate 1-year outcomes in this registry. Methods: This study was a multicenter retrospective review of clinical outcomes. Results: A total of 116 extreme surgical risk patients with severe MAC underwent TMVR; 106 had a procedure date >1 year before data-lock and were included in the analysis. Their mean age was 73 ± 12 years, and 68% were female. The mean Society of Thoracic Surgeons score was 15.3 ± 11.6%, and 90% were in New York Heart Association functional class III or IV. Thirty-day and 1-year all-cause mortality was 25% and 53.7%, respectively. Most patients who survived 30 days were alive at 1 year (49 of 77 [63.6%]), and the majority (71.8%) were in New York Heart Association functional class I or II. Echocardiography data at 1 year were available in 34 patients. Mean left ventricular ejection fraction was 58.6 ± 11.2%, mean mitral valve area was 1.9 ± 0.5 cm2, mean mitral gradient was 5.8 ± 2.2 mm Hg, and 75% had zero or trace mitral regurgitation. Conclusions: TMVR with balloon-expandable aortic valves in extreme surgical risk patients with severe MAC is feasible but associated with high 30-day and 1-year mortality. Most patients who survive the 30-day post-procedural period are alive at 1 year and have sustained improvement of symptoms and transcatheter valve performance. The role of TMVR in patients with MAC requires further evaluation in clinical trials.
KW - calcific mitral valve stenosis
KW - mitral annular calcification
KW - mitral valve disease
KW - mitral valve replacement
KW - transcatheter valve replacement
UR - http://www.scopus.com/inward/record.url?scp=85045432326&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85045432326&partnerID=8YFLogxK
U2 - 10.1016/j.jacc.2018.02.054
DO - 10.1016/j.jacc.2018.02.054
M3 - Article
VL - 71
SP - 1841
EP - 1853
JO - Journal of the American College of Cardiology
JF - Journal of the American College of Cardiology
SN - 0735-1097
IS - 17
ER -