Author + information
- Received October 9, 2017
- Revision received December 23, 2017
- Accepted January 2, 2018
- Published online April 2, 2018.
- Lee Joseph, MD, MSa,
- Mohammad Bashir, MDb,
- Qun Xiang, MSc,
- Babatunde A. Yerokun, MDc,
- Roland Albert Matsouaka, PhDc,d,
- Sreekanth Vemulapalli, MDc,
- Samir Kapadia, MDe,
- Joaquin E. Cigarroa, MDf and
- Firas Zahr, MDf,∗ ()
- aDivision of Cardiovascular Diseases, Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa
- bDivision of Cardiothoracic Surgery, Department of Surgery, University of Iowa Carver College of Medicine, Iowa City, Iowa
- cDuke Clinical Research Institute, Durham, North Carolina
- dDepartment of Biostatistics and Bioinformatics, Duke University, Durham, North Carolina
- eHeart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
- fKnight Cardiovascular Institute, Oregon Health & Sciences University, Portland, Oregon
- ↵∗Address for correspondence:
Dr. Firas Zahr, Knight Cardiovascular Institute, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, Oregon 97239.
Objectives This study sought to examine the prevalence of mitral stenosis (MS) and its impact on in-hospital and 1-year clinical outcomes among patients undergoing transcatheter aortic valve replacement (TAVR).
Background Patients with coexisting severe aortic stenosis and MS are increasingly being considered for TAVR.
Methods The study cohort included 44,755 patients (age ≥18 years) who underwent TAVR during November 1, 2011, to September 30, 2015, and were registered in Society of Thoracic Surgeons/American College of Cardiology Transcatheter Valve Therapies (TVT) Registry. One-year outcomes were assessed by linking TVT registry data of this cohort to patient-specific Centers for Medicare & Medicaid Services administrative claims data (n = 31,453). The primary outcome was the composite of death, stroke, heart failure–related hospitalization, and mitral valve intervention at 1 year.
Results MS was present in 11.6% of cohort (mean age, 82 years; 52% males), being severe in 2.7%. Severe MS was associated with higher in-hospital mortality rates (5.6% vs. 3.9% for nonsevere MS and 4.1% for no MS; p = 0.02). In contrast to those without MS, severe MS group had significantly higher risk for the primary outcome, mortality (1 year), and heart failure–related hospitalization (1 year) (adjusted hazard ratio: 1.2 [95% confidence interval (CI): 1.1 to 1.4], 1.2 [95% CI: 1.0 to 1.4], and 1.3 [95% CI: 1.1 to 1.5], respectively; p < 0.05 for all).
Conclusions Approximately one-tenth of patients undergoing TAVR have concomitant MS. Severe MS is an independent predictor of 1-year adverse clinical outcomes following TAVR. The higher risk for long-term adverse events must be considered when evaluating patients with combined aortic stenosis and MS for TAVR.
Dr. Vemulapalli has received research grants from the American College of Cardiology (significant), Society of Thoracic Surgeons (significant), Abbott Vascular (significant), Patient Centered Outcomes Research Institute (significant), and Boston Scientific; consulted for Novella (insignificant/modest) and Boston Scientific; received travel expenses from Medtronic; and received speaker fees from Boston Scientific. Dr. Zahr is a primary investigator for clinical trials sponsored by Edwards Lifesciences and Medtronic. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. The Society of Thoracic Surgeons/American College of Cardiology Transcatheter Valve Therapies Registry is an initiative of the Society of Thoracic Surgeons and the American College of Cardiology Foundation. The views expressed in this manuscript represent those of the authors and do not necessarily represent the official views of the American College of Cardiology or Society of Thoracic Surgeons.
- Received October 9, 2017.
- Revision received December 23, 2017.
- Accepted January 2, 2018.
- 2018 American College of Cardiology Foundation