Transcatheter Treatment of Residual Significant Mitral Regurgitation Following TAVR: A Multicenter Registry

Guy Witberg; Pablo Codner; Uri Landes; Marco Barbanti; Roberto Valvo; Ole De Backer; Joris F Ooms; Kolja Sievert; Abdallah El Sabbagh; Pilar Jimenez-Quevedo; Paul F Brennan; Alexander Sedaghat; Giulia Masiero; Paul Werner; Pavel Overtchouk; Yusuke Watanabe; Matteo Montorfano; Venu Reddy Bijjam; Manuel Hein; Claudia Fiorina; Dabit Arzamendi; Tania Rodriguez-Gabella; Felipe Fernández-Vázquez; Jose A Baz; Clemence Laperche; Carmelo Grasso; Luca Branca; Rodrigo Estévez-Loureiro; Tomás Benito-González; Ignacio J Amat Santos; Philipp Ruile; Darren Mylotte; Nicola Buzzatti; Nicolo Piazza; Martin Andreas; Giuseppe Tarantini; Jan-Malte Sinning; Mark S Spence; Luis Nombela-Franco; Mayra Guerrero; Horst Sievert; Lars Sondergaard; Nicolas M Van Mieghem; Didier Tchetche; John G Webb; Ran Kornowski

doi:10.1016/j.jcin.2020.07.014

Transcatheter Treatment of Residual Significant Mitral Regurgitation Following TAVR: A Multicenter Registry

Guy Witberg, Pablo Codner, Uri Landes, Marco Barbanti, Roberto Valvo, Ole De Backer, Joris F Ooms, Kolja Sievert, Abdallah El Sabbagh, Pilar Jimenez-Quevedo, Paul F Brennan, Alexander Sedaghat, Giulia Masiero, Paul Werner, Pavel Overtchouk, Yusuke Watanabe, Matteo Montorfano, Venu Reddy Bijjam, Manuel Hein, Claudia FiorinaDabit Arzamendi, Tania Rodriguez-Gabella, Felipe Fernández-Vázquez, Jose A Baz, Clemence Laperche, Carmelo Grasso, Luca Branca, Rodrigo Estévez-Loureiro, Tomás Benito-González, Ignacio J Amat Santos, Philipp Ruile, Darren Mylotte, Nicola Buzzatti, Nicolo Piazza, Martin Andreas, Giuseppe Tarantini, Jan-Malte Sinning, Mark S Spence, Luis Nombela-Franco, Mayra Guerrero, Horst Sievert, Lars Sondergaard, Nicolas M Van Mieghem, Didier Tchetche, John G Webb, Ran Kornowski

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41 Citationer (Scopus)

Abstract

OBJECTIVES: The aim of this study was to describe baseline characteristics, and periprocedural and mid-term outcomes of patients undergoing transcatheter mitral valve interventions post-transcatheter aortic valve replacement (TAVR) and examine their clinical benefit.

BACKGROUND: The optimal management of residual mitral regurgitation (MR) post-TAVR is challenging.

METHODS: This was an international registry of 23 TAVR centers.

RESULTS: In total, 106 of 24,178 patients (0.43%) underwent mitral interventions post-TAVR (100 staged, 6 concomitant), most commonly percutaneous edge-to-edge mitral valve repair (PMVR). The median interval post-TAVR was 164 days. Mean age was 79.5 ± 7.2 years, MR was >moderate in 97.2%, technical success was 99.1%, and 30-day device success rate was 88.7%. There were 18 periprocedural complications (16.9%) including 4 deaths. During a median follow-up of 464 days, the cumulative risk for 3-year mortality was 29.0%. MR grade and New York Heart Association (NYHA) functional class improved dramatically; at 1 year, MR was moderate or less in 90.9% of patients (mild or less in 69.1%), and 85.9% of patients were in NYHA functional class I/II. Staged PMVR was associated with lower mortality versus medical treatment (57.5% vs. 30.8%) in a propensity-matched cohort (n = 156), but this was not statistically significant (hazard ratio: 1.75; p = 0.05).

CONCLUSIONS: For patients who continue to have significant MR, remain symptomatic post-TAVR, and are anatomically suitable for transcatheter interventions, these interventions are feasible, safe, and associated with significant improvement in MR grade and NYHA functional class. These results apply mainly to PMVR. A staged PMVR strategy was associated with markedly lower mortality, but this was not statistically significant. (Transcatheter Treatment for Combined Aortic and Mitral Valve Disease. The Aortic+Mitral TRAnsCatheter Valve Registry [AMTRAC]; NCT04031274).

Originalsprog	Engelsk
Tidsskrift	JACC: Cardiovascular Interventions
Vol/bind	13
Udgave nummer	23
Sider (fra-til)	2782-2791
Antal sider	10
ISSN	1936-8798
DOI	https://doi.org/10.1016/j.jcin.2020.07.014
Status	Udgivet - 14 dec. 2020

Adgang til dokumentet

10.1016/j.jcin.2020.07.014

Citationsformater

Witberg, G., Codner, P., Landes, U., Barbanti, M., Valvo, R., De Backer, O., Ooms, J. F., Sievert, K., El Sabbagh, A., Jimenez-Quevedo, P., Brennan, P. F., Sedaghat, A., Masiero, G., Werner, P., Overtchouk, P., Watanabe, Y., Montorfano, M., Bijjam, V. R., Hein, M., ... Kornowski, R. (2020). Transcatheter Treatment of Residual Significant Mitral Regurgitation Following TAVR: A Multicenter Registry. JACC: Cardiovascular Interventions, 13(23), 2782-2791. https://doi.org/10.1016/j.jcin.2020.07.014

Witberg, G, Codner, P, Landes, U, Barbanti, M, Valvo, R, De Backer, O, Ooms, JF, Sievert, K, El Sabbagh, A, Jimenez-Quevedo, P, Brennan, PF, Sedaghat, A, Masiero, G, Werner, P, Overtchouk, P, Watanabe, Y, Montorfano, M, Bijjam, VR, Hein, M, Fiorina, C, Arzamendi, D, Rodriguez-Gabella, T, Fernández-Vázquez, F, Baz, JA, Laperche, C, Grasso, C, Branca, L, Estévez-Loureiro, R, Benito-González, T, Amat Santos, IJ, Ruile, P, Mylotte, D, Buzzatti, N, Piazza, N, Andreas, M, Tarantini, G, Sinning, J-M, Spence, MS, Nombela-Franco, L, Guerrero, M, Sievert, H, Sondergaard, L, Van Mieghem, NM, Tchetche, D, Webb, JG & Kornowski, R 2020, 'Transcatheter Treatment of Residual Significant Mitral Regurgitation Following TAVR: A Multicenter Registry', JACC: Cardiovascular Interventions, bind 13, nr. 23, s. 2782-2791. https://doi.org/10.1016/j.jcin.2020.07.014

@article{0919ac12965f4c5ea5b8ac1cc165257a,

title = "Transcatheter Treatment of Residual Significant Mitral Regurgitation Following TAVR: A Multicenter Registry",

abstract = "OBJECTIVES: The aim of this study was to describe baseline characteristics, and periprocedural and mid-term outcomes of patients undergoing transcatheter mitral valve interventions post-transcatheter aortic valve replacement (TAVR) and examine their clinical benefit.BACKGROUND: The optimal management of residual mitral regurgitation (MR) post-TAVR is challenging.METHODS: This was an international registry of 23 TAVR centers.RESULTS: In total, 106 of 24,178 patients (0.43%) underwent mitral interventions post-TAVR (100 staged, 6 concomitant), most commonly percutaneous edge-to-edge mitral valve repair (PMVR). The median interval post-TAVR was 164 days. Mean age was 79.5 ± 7.2 years, MR was >moderate in 97.2%, technical success was 99.1%, and 30-day device success rate was 88.7%. There were 18 periprocedural complications (16.9%) including 4 deaths. During a median follow-up of 464 days, the cumulative risk for 3-year mortality was 29.0%. MR grade and New York Heart Association (NYHA) functional class improved dramatically; at 1 year, MR was moderate or less in 90.9% of patients (mild or less in 69.1%), and 85.9% of patients were in NYHA functional class I/II. Staged PMVR was associated with lower mortality versus medical treatment (57.5% vs. 30.8%) in a propensity-matched cohort (n = 156), but this was not statistically significant (hazard ratio: 1.75; p = 0.05).CONCLUSIONS: For patients who continue to have significant MR, remain symptomatic post-TAVR, and are anatomically suitable for transcatheter interventions, these interventions are feasible, safe, and associated with significant improvement in MR grade and NYHA functional class. These results apply mainly to PMVR. A staged PMVR strategy was associated with markedly lower mortality, but this was not statistically significant. (Transcatheter Treatment for Combined Aortic and Mitral Valve Disease. The Aortic+Mitral TRAnsCatheter Valve Registry [AMTRAC]; NCT04031274).",

author = "Guy Witberg and Pablo Codner and Uri Landes and Marco Barbanti and Roberto Valvo and {De Backer}, Ole and Ooms, {Joris F} and Kolja Sievert and {El Sabbagh}, Abdallah and Pilar Jimenez-Quevedo and Brennan, {Paul F} and Alexander Sedaghat and Giulia Masiero and Paul Werner and Pavel Overtchouk and Yusuke Watanabe and Matteo Montorfano and Bijjam, {Venu Reddy} and Manuel Hein and Claudia Fiorina and Dabit Arzamendi and Tania Rodriguez-Gabella and Felipe Fern{\'a}ndez-V{\'a}zquez and Baz, {Jose A} and Clemence Laperche and Carmelo Grasso and Luca Branca and Rodrigo Est{\'e}vez-Loureiro and Tom{\'a}s Benito-Gonz{\'a}lez and {Amat Santos}, {Ignacio J} and Philipp Ruile and Darren Mylotte and Nicola Buzzatti and Nicolo Piazza and Martin Andreas and Giuseppe Tarantini and Jan-Malte Sinning and Spence, {Mark S} and Luis Nombela-Franco and Mayra Guerrero and Horst Sievert and Lars Sondergaard and {Van Mieghem}, {Nicolas M} and Didier Tchetche and Webb, {John G} and Ran Kornowski",

year = "2020",

month = dec,

day = "14",

doi = "10.1016/j.jcin.2020.07.014",

language = "English",

volume = "13",

pages = "2782--2791",

journal = "JACC: Cardiovascular Interventions",

issn = "1936-8798",

publisher = "Elsevier Inc.",

number = "23",

}

TY - JOUR

T1 - Transcatheter Treatment of Residual Significant Mitral Regurgitation Following TAVR

T2 - A Multicenter Registry

AU - Witberg, Guy

AU - Codner, Pablo

AU - Landes, Uri

AU - Barbanti, Marco

AU - Valvo, Roberto

AU - De Backer, Ole

AU - Ooms, Joris F

AU - Sievert, Kolja

AU - El Sabbagh, Abdallah

AU - Jimenez-Quevedo, Pilar

AU - Brennan, Paul F

AU - Sedaghat, Alexander

AU - Masiero, Giulia

AU - Werner, Paul

AU - Overtchouk, Pavel

AU - Watanabe, Yusuke

AU - Montorfano, Matteo

AU - Bijjam, Venu Reddy

AU - Hein, Manuel

AU - Fiorina, Claudia

AU - Arzamendi, Dabit

AU - Rodriguez-Gabella, Tania

AU - Fernández-Vázquez, Felipe

AU - Baz, Jose A

AU - Laperche, Clemence

AU - Grasso, Carmelo

AU - Branca, Luca

AU - Estévez-Loureiro, Rodrigo

AU - Benito-González, Tomás

AU - Amat Santos, Ignacio J

AU - Ruile, Philipp

AU - Mylotte, Darren

AU - Buzzatti, Nicola

AU - Piazza, Nicolo

AU - Andreas, Martin

AU - Tarantini, Giuseppe

AU - Sinning, Jan-Malte

AU - Spence, Mark S

AU - Nombela-Franco, Luis

AU - Guerrero, Mayra

AU - Sievert, Horst

AU - Sondergaard, Lars

AU - Van Mieghem, Nicolas M

AU - Tchetche, Didier

AU - Webb, John G

AU - Kornowski, Ran

PY - 2020/12/14

Y1 - 2020/12/14

N2 - OBJECTIVES: The aim of this study was to describe baseline characteristics, and periprocedural and mid-term outcomes of patients undergoing transcatheter mitral valve interventions post-transcatheter aortic valve replacement (TAVR) and examine their clinical benefit.BACKGROUND: The optimal management of residual mitral regurgitation (MR) post-TAVR is challenging.METHODS: This was an international registry of 23 TAVR centers.RESULTS: In total, 106 of 24,178 patients (0.43%) underwent mitral interventions post-TAVR (100 staged, 6 concomitant), most commonly percutaneous edge-to-edge mitral valve repair (PMVR). The median interval post-TAVR was 164 days. Mean age was 79.5 ± 7.2 years, MR was >moderate in 97.2%, technical success was 99.1%, and 30-day device success rate was 88.7%. There were 18 periprocedural complications (16.9%) including 4 deaths. During a median follow-up of 464 days, the cumulative risk for 3-year mortality was 29.0%. MR grade and New York Heart Association (NYHA) functional class improved dramatically; at 1 year, MR was moderate or less in 90.9% of patients (mild or less in 69.1%), and 85.9% of patients were in NYHA functional class I/II. Staged PMVR was associated with lower mortality versus medical treatment (57.5% vs. 30.8%) in a propensity-matched cohort (n = 156), but this was not statistically significant (hazard ratio: 1.75; p = 0.05).CONCLUSIONS: For patients who continue to have significant MR, remain symptomatic post-TAVR, and are anatomically suitable for transcatheter interventions, these interventions are feasible, safe, and associated with significant improvement in MR grade and NYHA functional class. These results apply mainly to PMVR. A staged PMVR strategy was associated with markedly lower mortality, but this was not statistically significant. (Transcatheter Treatment for Combined Aortic and Mitral Valve Disease. The Aortic+Mitral TRAnsCatheter Valve Registry [AMTRAC]; NCT04031274).

AB - OBJECTIVES: The aim of this study was to describe baseline characteristics, and periprocedural and mid-term outcomes of patients undergoing transcatheter mitral valve interventions post-transcatheter aortic valve replacement (TAVR) and examine their clinical benefit.BACKGROUND: The optimal management of residual mitral regurgitation (MR) post-TAVR is challenging.METHODS: This was an international registry of 23 TAVR centers.RESULTS: In total, 106 of 24,178 patients (0.43%) underwent mitral interventions post-TAVR (100 staged, 6 concomitant), most commonly percutaneous edge-to-edge mitral valve repair (PMVR). The median interval post-TAVR was 164 days. Mean age was 79.5 ± 7.2 years, MR was >moderate in 97.2%, technical success was 99.1%, and 30-day device success rate was 88.7%. There were 18 periprocedural complications (16.9%) including 4 deaths. During a median follow-up of 464 days, the cumulative risk for 3-year mortality was 29.0%. MR grade and New York Heart Association (NYHA) functional class improved dramatically; at 1 year, MR was moderate or less in 90.9% of patients (mild or less in 69.1%), and 85.9% of patients were in NYHA functional class I/II. Staged PMVR was associated with lower mortality versus medical treatment (57.5% vs. 30.8%) in a propensity-matched cohort (n = 156), but this was not statistically significant (hazard ratio: 1.75; p = 0.05).CONCLUSIONS: For patients who continue to have significant MR, remain symptomatic post-TAVR, and are anatomically suitable for transcatheter interventions, these interventions are feasible, safe, and associated with significant improvement in MR grade and NYHA functional class. These results apply mainly to PMVR. A staged PMVR strategy was associated with markedly lower mortality, but this was not statistically significant. (Transcatheter Treatment for Combined Aortic and Mitral Valve Disease. The Aortic+Mitral TRAnsCatheter Valve Registry [AMTRAC]; NCT04031274).

U2 - 10.1016/j.jcin.2020.07.014

DO - 10.1016/j.jcin.2020.07.014

M3 - Journal article

C2 - 33303117

SN - 1936-8798

VL - 13

SP - 2782

EP - 2791

JO - JACC: Cardiovascular Interventions

JF - JACC: Cardiovascular Interventions

IS - 23

ER -

Transcatheter Treatment of Residual Significant Mitral Regurgitation Following TAVR: A Multicenter Registry

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