Prosthetic Mitral Surgical Valve in Transcatheter Aortic Valve Replacement Recipients

• Published in: JACC. Cardiovascular interventions Vol. 10; no. 19; pp. 1973 - 1981
• Main Authors: Amat-Santos, Ignacio J., Cortés, Carlos, Nombela Franco, Luis, Muñoz-García, Antonio J., Suárez De Lezo, Jose, Gutiérrez-Ibañes, Enrique, Serra, Vicenç, Larman, Mariano, Moreno, Raúl, De La Torre Hernandez, Jose M., Puri, Rishi, Jimenez-Quevedo, Pilar, Hernández García, José M., Alonso-Briales, Juan H., García, Bruno, Lee, Dae-Hyun, Rojas, Paol, Sevilla, Teresa, Goncalves, Renier, Vera, Silvio, Gómez, Itziar, Rodés-Cabau, Josep, San Román, José A.
• Format: Journal Article
• Language: English
• Published: Elsevier Inc 01.10.2017
• Subjects: mitral prostheses; multivalvular disease; TAVR; multivalvular disease; LMWH; UFH; PMV; mitral prostheses; CABG; TAVR
• ISSN: 1936-8798; 1876-7605
• DOI: 10.1016/j.jcin.2017.07.045

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). TAVR is performed relatively often in patients with PMVs, but specific risks are not well described. 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. 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. 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. [Display omitted]