Transcatheter Mitral Valve Replacement in Native Mitral Valve Disease With Severe Mitral Annular Calcification Results From the First Multicenter Global Registry

Transcatheter Mitral Valve Replacement in Native Mitral Valve Disease With Severe Mitral Annular Calcification Results From the First Multicenter Global Registry

Author Guerrero, Mayra Google Scholar
Dvir, Danny Google Scholar
Himbert, Dominique Google Scholar
Urena, Marina Google Scholar
Eleid, Mackram Google Scholar
Wang, Dee Dee Google Scholar
Greenbaum, Adam Google Scholar
Mahadevan, Vaikom S. Google Scholar
Holzhey, David Google Scholar
O'Hair, Daniel Google Scholar
Dumonteil, Nicolas Google Scholar
Rodes-Cabau, Josep Google Scholar
Piazza, Nicolo Google Scholar
Palma, Jose H. Autor UNIFESP Google Scholar
DeLago, Augustin Google Scholar
Ferrari, Enrico Google Scholar
Witkowski, Adam Google Scholar
Wendler, Olaf Google Scholar
Kornowski, Ran Google Scholar
Martinez-Clark, Pedro Google Scholar
Ciaburri, Daniel Google Scholar
Shemin, Richard Google Scholar
Alnasser, Sami Google Scholar
McAllister, David Google Scholar
Bena, Martin Google Scholar
Kerendi, Faraz Google Scholar
Pavlides, Gregory Google Scholar
Sobrinho, Jose J. Google Scholar
Attizzani, Guilherme F. Google Scholar
George, Isaac Google Scholar
Nickenig, George Google Scholar
Fassa, Amir-Ali Google Scholar
Cribier, Alain Google Scholar
Bapat, Vinnie Google Scholar
Feldman, Ted Google Scholar
Rihal, Charanjit Google Scholar
Vahanian, Alec Google Scholar
Webb, John Google Scholar
O'Neill, William Google Scholar
Abstract OBJECTIVES This study sought to evaluate the outcomes of the early experience of transcatheter mitral valve replacement (TMVR) with balloon-expandable valves in patients with severe mitral annular calcification (MAC) and reports the first large series from a multicenter global registry. BACKGROUND The risk of surgical mitral valve replacement in patients with severe MAC is high. There are isolated reports of successful TMVR with balloon-expandable valves in this patient population. METHODS We performed a multicenter retrospective review of clinical outcomes of patients with severe MAC undergoing TMVR. RESULTS From September 2012 to July of 2015, 64 patients in 32 centers underwent TMVR with compassionate use of balloon-expandable valves. Mean age was 73 +/- 13 years, 66% were female, and mean Society of Thoracic Surgeons score was 14.4 +/- 9.5%. The mean mitral gradient was 11.45 +/- 4.4 mm Hg and the mean mitral area was 1.18 +/- 0.5 cm(2). SAPIEN valves (Edwards Lifesciences, Irvine, California) were used in 7.8%, SAPIEN XT in 59.4%, SAPIEN 3 in 28.1%, and Inovare (Braile Biomedica, Brazil) in 4.7%. Access was transatrial in 15.6%, transapical in 43.8%, and transseptal in 40.6%. Technical success according to Mitral Valve Academic Research Consortium criteria was achieved in 46 (72%) patients, primarily limited by the need for a second valve in 11 (17.2%). Six (9.3%) had left ventricular tract obstruction with hemodynamic compromise. Mean mitral gradient post-procedure was 4 +/- 2.2 mm Hg, paravalvular regurgitation was mild or absent in all. Thirty-day all-cause mortality was 29.7% (cardiovascular = 12.5% and noncardiac = 17.2%)

84% of the survivors with follow-up data available were in New York Heart Association functional class I or II at 30 days (n = 25). CONCLUSIONS TMVR with balloon-expandable valves in patients with severe MAC is feasible but may be associated with significant adverse events. This strategy might be an alternative for selected high-risk patients with limited treatment options. (C) 2016 by the American College of Cardiology Foundation.
Keywords calcific mitral stenosis
mitral annular calcification
mitral valve disease
mitral valve replacement
transcatheter valve replacement
xmlui.dri2xhtml.METS-1.0.item-coverage New York
Language English
Sponsor Edwards Lifesciences
Boston Scientific
Date 2016
Published in Jacc-Cardiovascular Interventions. New York, v. 9, n. 13, p. 1361-1371, 2016.
ISSN 1936-8798 (Sherpa/Romeo, impact factor)
Publisher Elsevier Science Inc
Extent 1361-1371
Access rights Closed access
Type Article
Web of Science ID WOS:000379507900013

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