Transcatheter aortic valve replacement in patients with severe mitral or tricuspid regurgitation at extreme risk for surgery

The Journal of Thoracic and Cardiovascular Surgery

Alan Hartman¹  G. Michael Deeb²  Stanley Katz³  Daniel O'Hair⁴  Neal S. Kleiman⁵  Brijeshwar Maini⁶  Steven J. Yakubov⁷  Mubashir Mumtaz⁸  Tanvir Bajwa⁹  Stephen H. Little^1,10  Jeffrey J. Popma^1,11  Thomas G. Gleason^1,12  Stan Checuti^1,13 

[1] Clinical Services and Statistical Services, Medtronic, Minneapolis, Minn;Department of Cardiothoracic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pa;Department of Cardiovascular Surgery, Mount Sinai Health System, New York, NY;Department of Intervention Cardiology, Delray Medical Center, Delray Beach, Fla;Departments of Cardiac Surgery and Interventional Cardiology, University of Michigan Hospitals, Ann Arbor, Mich;Departments of Cardiothoracic Surgery and Interventional Cardiology, Spectrum Health Hospitals, Grand Rapids, Mich;Departments of Cardiothoracic Surgery and Interventional Cardiology, St Luke's Medical Center, Aurora Health Care, Milwaukee, Wis;Departments of Cardiothoracic and Vascular Surgery and Interventional Cardiology, St Francis Hospital, Roslyn, NY;Departments of Cardiovascular Surgery and Interventional Cardiology, North Shore University Hospital, Manhasset, NY;Houston Methodist DeBakey Heart & Vascular Center, Departments of Cardiothoracic Surgery and Cardiology, Houston, Tex;Interventional Cardiology, Beth Israel Deaconess Medical Center, Boston, Mass;Interventional Cardiology, Riverside Methodist Hospital, Columbus, Ohio;Pinnacle Health Harrisburg Hospital, Harrisburg, Pa

关键词: aortic stenosis;    transcatheter aortic valve replacement;    mitral valve regurgitation;    tricuspid valve regurgitation;   

DOI  :  10.1016/j.jtcvs.2017.11.108

学科分类：心脏病和心血管学

来源: Mosby, Inc.

【 摘 要 】

ObjectivesPatients with symptomatic severe aortic stenosis and severe mitral regurgitation or severe tricuspid regurgitation were excluded from the major transcatheter aortic valve replacement trials. We studied these 2 subgroups in patients at extreme risk for surgery in the prospective, nonrandomized, single-arm CoreValve US Expanded Use Study.MethodsThe primary end point was all-cause mortality or major stroke at 1 year. A favorable medical benefit was defined as a Kansas City Cardiomyopathy Questionnaire overall summary score greater than 45 at 6 months and greater than 60 at 1 year and with a less than 10-point decrease from baseline.ResultsThere were 53 patients in each group. Baseline characteristics for the severe mitral regurgitation and severe tricuspid regurgitation cohorts were age 84.2 ± 6.4 years and 84.9 ± 6.5 years; male, 29 (54.7%) and 22 (41.5%), and mean Society of Thoracic Surgeons score 9.9% ± 5.0% and 9.2% ± 4.0%, respectively. Improvement in valve regurgitation from baseline to 1 year occurred in 72.7% of the patients with severe mitral regurgitation and in 61.8% of patients with severe tricuspid regurgitation. A favorable medical benefit occurred in 31 of 47 patients (66.0%) with severe mitral regurgitation and 33 of 47 patients (70.2%) with severe tricuspid regurgitation at 6 months, and in 25 of 44 patients (56.8%) with severe mitral regurgitation and 24 of 45 patients (53.3%) with severe tricuspid regurgitation at 1 year. All-cause mortality or major stroke for the severe mitral regurgitation and severe tricuspid regurgitation cohorts were 11.3% and 3.8% at 30 days and 21.0% and 19.2% at 1 year, respectively. There were no major strokes in either group at 1 year.ConclusionsTranscatheter aortic valve replacement in patients with severe mitral regurgitation or severe tricuspid regurgitation is reasonable and safe and leads to improvement in atrioventricular valve regurgitation.

【 授权许可】

Unknown