Author + information
- Received January 16, 2018
- Revision received March 5, 2018
- Accepted March 5, 2018
- Published online June 18, 2018.
- Norihiko Kamioka, MDa,
- Vasilis Babaliaros, MDa,∗ (, )
- Michael Andrew Morse, MDb,
- Tiberio Frisoli, MDc,
- Stamatios Lerakis, MDa,
- Jose Miguel Iturbe, MDa,
- Jose Binongo, PhDd,
- Frank Corrigan, MDa,
- Altayyeb Yousef, MDa,
- Patrick Gleason, MDa,
- John A. Wells IV, MDa,
- Hope Caughron, BAa,
- Andy Dong, BSa,
- Evelio Rodriguez, MDe,
- Bradley Leshnower, MDf,
- William O’Neill, MDc,
- Gaetano Paone, MDg,
- Marvin Eng, MDc,
- Robert Guyton, MDf,
- Peter C. Block, MDa and
- Adam Greenbaum, MDc
- aDivision of Cardiology, Emory University School of Medicine, Atlanta, Georgia
- bDivision of Cardiology, Saint Thomas Health, Nashville, Tennessee
- cDivision of Cardiology, Henry Ford Health System, Detroit, Michigan
- dRollins School of Public Health, Emory University School of Medicine, Atlanta, Georgia
- eDivision of Cardiothoracic Surgery, Saint Thomas Health, Nashville, Tennessee
- fDivision of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Georgia
- gDivision of Cardiac Surgery, Henry Ford Health System, Detroit, Michigan
- ↵∗Address for correspondence:
Dr. Vasilis Babaliaros, Emory University Hospital F606, 1364 Clifton Road, Atlanta, Georgia 30322.
Objectives There are minimal data regarding clinical outcomes and echocardiographic findings after transcatheter mitral valve-in-valve replacement (TMVR) compared with redo surgical mitral valve replacement (SMVR).
Background TMVR therapy has emerged as therapy for a degenerated bioprosthetic valve failure.
Methods The authors retrospectively identified patients with degenerated mitral bioprostheses who underwent redo SMVR or TMVR at 3 U.S. institutions. The authors compared clinical and echocardiographic outcomes of patients who had TMVR with those of patients who underwent redo SMVR.
Results Sixty-two patients underwent TMVR and 59 patients underwent SMVR during the study period. Mean age and the Society of Thoracic Surgeons Predicted Risk of Mortality (STS PROM) scores were significantly higher in patients with TMVR than in those with SMVR (age 74.9 ± 9.4 years vs. 63.7 ± 14.9 years; p < 0.001; STS PROM 12.7 ± 8.0% vs. 8.7 ± 10.1%; p < 0.0001). Total procedure time, intensive care unit hours, and post-procedure length of stay were all significantly shorter in the TMVR group. There was no difference in mortality at 1 year between the 2 groups (TMVR 11.3% vs. SMVR 11.9%; p = 0.92). Mean mitral valve pressure gradient and the grade of mitral regurgitation (MR) were similar between the TMVR group and the SMVR group (mitral valve pressure gradient 7.1 ± 2.5 mm Hg vs. 6.5 ± 2.5 mm Hg; p = 0.42; MR [≥moderate] 3.8% vs. 5.6%; p = 1.00) at 30 days. At 1 year, the mitral valve pressure gradient was higher in the TMVR group (TMVR 7.2 ± 2.7 vs. SMVR 5.5 ± 1.8; p = 0.01), although there was no difference in the grade of MR.
Conclusions Despite the higher STS PROM in TMVR patients, there was no difference in 1-year mortality between the TMVR and SMVR groups. Echocardiographic findings after TMVR were similar to SMVR at 30 days. There was a statistically significant difference in mitral gradient at 1 year, though this is likely not clinically important. TMVR may be an alternative to SMVR in patients with previous mitral bioprosthetic valves.
Dr. Babaliaros has been a consultant for and received research grant support from Abbott Vascular and Edwards Lifesciences. Dr. Lerakis has been a consultant for Edwards Lifesciences and Abbott Vascular. Dr. Leshnower has served on the Speakers Bureau for Medtronic. Dr. O’Neill has been a consultant for Edwards Lifesciences, Medtronic, Boston Scientific, Abbott Vascular, and St. Jude Medical; and serves on the Board of Directors of Neovasc Inc. Dr. Eng has been a proctor for Edwards Lifesciences. Dr. Guyton has served as the national principal investigator on the Edwards Lifesciences TMVR early feasibility trial. Dr. Greenbaum has been a proctor for Edwards Lifesciences and St. Jude Medical. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received January 16, 2018.
- Revision received March 5, 2018.
- Accepted March 5, 2018.
- 2018 American College of Cardiology Foundation
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