Author + information
- Received November 8, 2019
- Revision received February 7, 2020
- Accepted March 13, 2020
- Published online July 6, 2020.
- Faisal Khan, MBBS∗,
- Taishi Okuno, MD∗,
- Daniel Malebranche, MD,
- Jonas Lanz, MD,
- Fabien Praz, MD,
- Stefan Stortecky, MD,
- Stephan Windecker, MD and
- Thomas Pilgrim, MD∗ ()
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- ↵∗Address for correspondence:
Dr. Thomas Pilgrim, Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, CH-3010 Bern, Switzerland.
• MR is the most common valvulopathy in TAVR patients, followed by TR, MS, and AR.
• Both coexistent MR and MS may result in underestimation of AS and portends a worse outcome after TAVR.
• AR at baseline may be protective against the deleterious effects of post-TAVR paravalvular leak.
• Further research is needed to define the timing and role of tricuspid intervention.
As transcatheter aortic valve replacement becomes a more dominant treatment option across all risk profiles, the frequency of encountering patients with multivalvular disease will increase. Furthermore, percutaneous interventions to treat other valvular lesions are also evolving. Understanding the clinical implications and treatment options for a second valvular lesion is becoming increasingly important to guide heart team decisions, and this paper aims to review the evidence around these situations. Diagnosis of multivalvular disease can be challenging because of changes in physiology. There are little randomized data to guide therapy in multivalvular disease. Multidisciplinary heart team decisions can be invaluable in integrating the plethora of clinical, hemodynamic, and imaging data on which an optimal management strategy can be planned. Prospective studies to assess the role of structural valve interventions in the transcatheter aortic valve replacement era would greatly help improve outcomes for structural heart patients.
- aortic regurgitation
- mitral regurgitation
- mitral stenosis
- transcatheter aortic valve replacement
- tricuspid regurgitation
↵∗ Drs. Khan and Okuno contributed equally to this work.
Dr. Okuno has received speaker fees from Abbott. Dr. Stortecky has received institutional research grant support from Edwards Lifesciences, Medtronic, Abbott Vascular, and Boston Scientific; and has served as a speaker for and received consulting fees from Boston Scientific, British Technology Group, and Teleflex. Dr. Windecker has received institutional research grant support from Abbott, Amgen, Bristol-Myers Squibb, Bayer, Biotronik, Boston Scientific, Edwards Lifesciences, Medtronic, The Medicines Company, St. Jude Medical, and Terumo. Dr. Pilgrim has received institutional research grant support from Edwards Lifesciences, Symetis, and Biotronik; has received speaker fees from Biotronik and Boston Scientific; and has served as a consultant for HighLife SAS. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
The authors attest they are in compliance with human studies committees and animal welfare regulations of the authors’ institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the JACC: Cardiovascular Interventions author instructions page.
- Received November 8, 2019.
- Revision received February 7, 2020.
- Accepted March 13, 2020.
- 2020 American College of Cardiology Foundation
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