Author + information
- Received April 12, 2017
- Revision received July 13, 2017
- Accepted July 19, 2017
- Published online October 2, 2017.
- Ignacio J. Amat-Santos, MD, PhDa,∗ (, )
- Carlos Cortés, MDb,
- Luis Nombela Franco, MD, PhDc,
- Antonio J. Muñoz-García, MDd,
- Jose Suárez De Lezo, MD, PhDe,
- Enrique Gutiérrez-Ibañes, MD, PhDf,
- Vicenç Serra, MDg,
- Mariano Larman, MD, PhDh,
- Raúl Moreno, MD, PhDi,
- Jose M. De La Torre Hernandez, MD, PhDj,
- Rishi Puri, MBBS, PhDk,l,m,
- Pilar Jimenez-Quevedo, MD, PhDc,
- José M. Hernández García, MDd,
- Juan H. Alonso-Briales, MDd,
- Bruno García, MDg,
- Dae-Hyun Lee, MDj,
- Paol Rojas, MDb,
- Teresa Sevilla, MDa,
- Renier Goncalves, MDa,
- Silvio Vera, MDb,
- Itziar Gómez, MSca,
- Josep Rodés-Cabau, MD, PhDk and
- José A. San Román, MD, PhDa
- aCIBERCV, Hospital Clínico Universitario, Valladolid, Spain
- bInstitute of Heart Sciences, Hospital Clínico Universitario, Valladolid, Spain
- cHospital Clínico Universitario San Carlos, Madrid, Spain
- dCIBERCV, Hospital Clínico Universitario Virgen de la Victoria, Málaga, Spain
- eHospital Universitario Reina Sofía, Córdoba, Spain
- fHospital General Universitario Gregorio Marañon, Madrid, Spain
- gHospital Universitario Vall D’Hebron, Barcelona, Spain
- hHospital Universitario Donostia, San Sebastián, Spain
- iHospital Universitario La Paz, Madrid, Spain
- jHospital Universitario Marques de Valdecilla, Santander, Spain
- kInstitute Universitaire de Cardiologie et Pneumologie de Quebec, Ville de Québec, Québec, Canada
- lDepartment of Medicine, University of Adelaide, Australia
- mCleveland Clinic Coordinating Center for Clinical Research, Cleveland, Ohio
- ↵∗Address for correspondence:
Dr. Ignacio J. Amat-Santos, Instituto de Ciencias del Corazón, Hospital Clínico Universitario de Valladolid, Ramón y Cajal 3, 47005 Valladolid, Spain.
Objectives The aim of this study was to determine the prognosis and specific complications of patients with prosthetic mitral valves (PMVs) undergoing transcatheter aortic valve replacement (TAVR).
Background TAVR is performed relatively often in patients with PMVs, but specific risks are not well described.
Methods A multicenter analysis was conducted, including patients with severe symptomatic aortic stenosis who underwent TAVR at 10 centers. Patients’ clinical characteristics and outcomes were evaluated according to the presence of a PMV.
Results The mean age of the study population (n = 2,414) was 81 ± 8 years, and 48.8% were men. A total of 91 patients (3.77%) had PMVs. They were more commonly women, younger, and had higher surgical risk. PMVs were implanted a median of 14 years before TAVR, and most patients had mechanical prostheses (73.6%). Eighty-six patients (94.5%) were on long-term vitamin K inhibitor therapy, and bridging antithrombotic therapy was administered in 59 (64.8%). TAVR device embolization occurred in 6.7% (vs. 3.3% in the non-PMV group; p = 0.127), in all instances when distance between the PMV and the aortic annulus was <7 mm. Mortality rates did not show a difference, but the rate of bleeding was higher in patients with PMV (24.2% vs. 16.1%; p = 0.041), even in those treated via the transfemoral approach (22.2% vs. 13.9%; p = 0.048). Indeed, bleeding complications, prior atrial fibrillation, chronic obstructive pulmonary disease, surgical risk, and New York Heart Association functional class were independent predictors of mortality.
Conclusions TAVR presents similar mortality irrespective of the presence of a PMV. However, patients with PMVs had higher bleeding risk that was independently associated with higher mortality. Risk for valve embolization was relatively high, but it occurred only in patients with PMV–to–aortic annulus distances <7 mm.
This work was supported by a grant from the CSC (Spain) to the Multivalvular Score Project, federal funds, and Fundación Carolina-BBVA. Dr. Amat-Santos is an advisor for Symetis. Dr. Nombela-Franco is an advisor for St. Jude Medical. Dr. Larman is an advisor for Edwards Lifesciences. Dr. Moreno is an advisor for Boston Scientific. Dr. García is an advisor for Edward Lifesciences. Dr. Rodés-Cabau is an advisor for Edwards Lifesciences, Medtronic, and St. Jude Medical. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received April 12, 2017.
- Revision received July 13, 2017.
- Accepted July 19, 2017.
- 2017 American College of Cardiology Foundation