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Rigshospitalet - a part of Copenhagen University Hospital
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Transcatheter Treatment of Residual Significant Mitral Regurgitation Following TAVR: A Multicenter Registry

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    Research output: Contribution to journalJournal articleResearchpeer-review

  • 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
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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).

Original languageEnglish
JournalJACC: Cardiovascular Interventions
Volume13
Issue number23
Pages (from-to)2782-2791
Number of pages10
ISSN1936-8798
DOIs
Publication statusPublished - 14 Dec 2020

ID: 62239142