Transcatheter Mitral Valve Replacement After Surgical Repair or Replacement: Comprehensive Mid-Term Evaluation of Valve-in-Valve and Valve-in-Ring Implantation from the VIVID Registry
- Simonato, Matheus The Cardiovascular Research Foundation, New York, NY; Escola Paulista de Medicina - Universidade Federal de São Paulo, São Paulo, Brazil
- Whisenant, Brian Intermountain Healthcare, Murray, UT
- Barbosa Ribeiro, Henrique Instituto do Coração da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
- Webb, John G. St. Paul's Hospital, Vancouver, Canada
- Kornowski, Ran Rabin Medical Center, Petah Tikva, Israel
- Guerrero, Mayra Mayo Clinic, Rochester, MN
- Wijeysundera, Harindra ORCID Sunnybrook Hospital, Toronto, Canada
- Søndergaard, Lars Rigshospitalet, Copenhagen, Denmark
- De Backer, Ole ORCID Rigshospitalet, Copenhagen, Denmark
- Villablanca, Pedro Henry Ford Hospital, Detroit, MI
- Rihal, Charanjit Mayo Clinic, Rochester, MN
- Eleid, Mackram ORCID Mayo Clinic, Rochester, MN
- Kempfert, Jörg Deutsches Herzzentrum Berlin, Berlin, Germany
- Unbehaun, Axel Deutsches Herzzentrum Berlin, Berlin, Germany
- Erlebach, Magdalena Deutsches Herzzentrum München, Munich, Germany
- Casselman, Filip Onze-Lieve-Vrouwziekenhuis, Aalst, Belgium
- Adam, Matti Uniklinik Köln, Köln, Germany
- Montorfano, Matteo I.R.C.C.S. Ospedale San Raffaele, Milan, Italy
- Ancona, Marco ORCID I.R.C.C.S. Ospedale San Raffaele, Milan, Italy
- Saia, Francesco Policlinico Sant'Orsola-Malpighi, Bologna, Italy
- Ubben, Timm Asklepios Klinik St. Georg, Hamburg, Germany
- Meincke, Felix Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany, GERMANY
- Napodano, Massimo Università degli Studi di Padova, Padova, Italy
- Codner, Pablo Rabin Medical Center, Petah Tikva, Israel
- Schofer, Joachim Medizinisches Versorgungszentrum, Hamburg, Germany
- Pelletier, Marc University Hospitals Harrington Heart & Vascular Institute, Cleveland, OH
- Cheung, Anson St. Paul's Hospital, Vancouver, Canada
- Shuvy, Mony Hadassah Medical Center, Jerusalem, Israel
- Palma, José Honório Escola Paulista de Medicina - Universidade Federal de São Paulo, São Paulo, Brazil; Instituto do Coração da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
- Gaia, Diego Felipe Escola Paulista de Medicina - Universidade Federal de São Paulo, São Paulo, Brazil
- Duncan, Alison The Royal Brompton Hospital, London, United Kingdom
- Hildick-Smith, David Brighton and Sussex University Hospitals, Brighton, United Kingdom;
- Veulemans, Verena ORCID Universitätsklinikum Düsseldorf, Düsseldorf, Germany
- Sinning, Jan-Malte Universitätsklinikum Bonn, Bonn, Germany
- Arbel, Yaron Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
- Testa, Luca I.R.C.C.S. Policlinico San Donato, Milan, Italy;
- de Weger, Arend Leids Universitair Medisch Centrum, Leiden, the Netherlands
- Eltchaninoff, Helene Rouen University Hospital, Rouen, France
- Hemery, Thibault Rouen University Hospital, Rouen, France
- Landes, Uri St. Paul's Hospital, Vancouver, Canada
- Tchetche, Didier Clinique Pasteur, Toulouse, France
- Dumonteil, Nicolas Clinique Pasteur, Toulouse, France
- Rodés-Cabau, Josep ORCID Institut Universitaire de Cardiologie et de Pneumologie de Québec, Québec City, Canada
- Kim, Won-Keun ORCID Kerckhoff-Klinik, Bad Nauheim, Germany
- Spargias, Konstantinos Hygeia Hospital, Athens, Greece
- Kourkoveli, Panagiota Hygeia Hospital, Athens, Greece
- Ben-Yehuda, Ori The Cardiovascular Research Foundation, New York, NY;University of California San Diego, San Diego, CA
- Campante Teles, Rui ORCID Hospital de Santa Cruz, Lisboa, Portugal
- Barbanti, Marco Università degli Studi di Catania, Catania, Italy
- Fiorina, Claudia Spedali Civili Brescia, Brescia, Italy
- Thukkani, Arun Central Maine Healthcare, Lewiston, ME
- Mackensen, G. Burkhard University of Washington, Seattle, WA
- Jones, Noah Mount Carmel Health System, Columbus, OH
- Presbitero, Patrizia Humanitas, Milan, Italy
- Petronio, Anna Sonia Università di Pisa, Pisa, Italy
- Allali, Abdelhakim ORCID Segeberger Kliniken, Bad Segeberg, Germany
- Champagnac, Didier Cardiologie Tonkin, Villeurbanne, France
- Bleiziffer, Sabine Herz- und Diabeteszentrum Nordrhein-Westfalen, Bad Oeynhausen, Germany;
- Rudolph, Tanja Herz- und Diabeteszentrum Nordrhein-Westfalen, Bad Oeynhausen, Germany;
- Iadanza, Alessandro ORCID Azienda Ospedaliera Universitaria Senese, Siena, Italy
- Salizzoni, Stefano ORCID Città della Salute e della Scienza - "Molinette" Hospital, Torino, Italy
- Agrifoglio, Marco Centro Cardiologico Monzino, Milan, Italy
- Nombela-Franco, Luis ORCID Hospital Clínico San Carlos, Madrid, Spain
- Bonaros, Nikolaos Medizinische Universität Innsbruck, Innsbruck, Austria
- Kass, Malek University of Manitoma, Winnipeg, Canada
- Bruschi, Giuseppe Ospedale Niguarda Ca' Granda, Milan, Italy
- Amabile, Nicolas Institut Mutualiste Montsouris, Paris, France
- Chhatriwalla, Adnan ORCID Saint Luke's Mid America Heart Institute, Kansas City, MO
- Messina, Antonio ORCID Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy
- Hirji, Sameer A. Brigham and Women's Hospital, Boston, MA
- Andreas, Martin Medizinische Universität Wien, Vienna, Austria;
- Welsh, Robert University of Alberta, Edmonton, Canada
- Schoels, Wolfgang Evangelisches Klinikum Niederrhein, Duisburg, Germany
- Hellig, Farrel Sunninghill Hospital, Johannesburg, South Africa
- Windecker, Stephan Inselspital, Bern, Switzerland;
- Stortecky, Stefan ORCID Inselspital, Bern, Switzerland;
- Maisano, Francesco Universitätsspital Zürich, Zurich, Switzerland;
- Stone, Gregg W. ORCID The Cardiovascular Research Foundation, New York, NY; The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY
- Dvir, Danny ORCID University of Washington, Seattle, WA
- 2020-9-25
Published in:
- Circulation. - Ovid Technologies (Wolters Kluwer Health). - 2020
English
Background:
Mitral valve-in-valve (ViV) and valve-in-ring (ViR) are alternatives to surgical reoperation in patients with recurrent mitral valve failure after previous surgical valve repair or replacement. Our aim was to perform a large-scale analysis examining mid-term outcomes after mitral ViV and ViR.
Methods:
Patients undergoing mitral ViV and ViR were enrolled in the Valve-in-Valve International Data Registry. Cases were performed between March 2006 and March 2020. Clinical endpoints are reported according to the Mitral Valve Academic Research Consortium (MVARC) definitions. Significant residual mitral stenosis (MS) was defined as mean gradient ≥10 mmHg and significant residual mitral regurgitation (MR) as ≥ moderate.
Results:
A total of 1,079 patients (857 ViV, 222 ViR; mean age 73.5 years ± 12.5; 40.8% male) from 90 centers were included. Median STS-PROM score 8.6%; median clinical follow-up 492 days [IQR 76 - 996 days]; median echocardiographic follow-up for patients that survived 1 year 772.5 days [IQR 510 - 1211.75 days]. Four-year Kaplan-Meier survival rate was 62.5% in ViV vs. 49.5% for ViR (p<0.001). Mean gradient across the mitral valve post-procedure was 5.7 ± 2.8 mmHg (≥5mmHg, 61.4% of patients). Significant residual MS occurred in 8.2% of the ViV and 12.0% of the ViR patients (p=0.09). Significant residual MR was more common in ViR patients (16.6% vs. 3.1%; p<0.001) and was associated with lower survival at 4 years (35.1% vs. 61.6%; p=0.02). The rates of MVARC-defined device success were low for both procedures (39.4% total; 32.0% ViR vs. 41.3% ViV; p=0.01), mostly related to having post-procedural mean gradient ≥5mmHg. Correlates for residual MS were smaller true internal diameter, younger age and larger body mass index. The only correlate for residual MR was ViR. Significant residual MS (SHR 4.67; 95% CI 1.74 - 12.56; p=0.002) and significant residual MR (SHR 7.88; 95% CI 2.88 - 21.53; p<0.001) were both independently associated with repeat mitral valve replacement.
Conclusions:
Significant residual MS and/or MR were not infrequent after mitral ViV and ViR procedures and were both associated with a need for repeat valve replacement. Strategies to improve post-procedural hemodynamics in mitral ViV and ViR should be further explored.
Mitral valve-in-valve (ViV) and valve-in-ring (ViR) are alternatives to surgical reoperation in patients with recurrent mitral valve failure after previous surgical valve repair or replacement. Our aim was to perform a large-scale analysis examining mid-term outcomes after mitral ViV and ViR.
Patients undergoing mitral ViV and ViR were enrolled in the Valve-in-Valve International Data Registry. Cases were performed between March 2006 and March 2020. Clinical endpoints are reported according to the Mitral Valve Academic Research Consortium (MVARC) definitions. Significant residual mitral stenosis (MS) was defined as mean gradient ≥10 mmHg and significant residual mitral regurgitation (MR) as ≥ moderate.
A total of 1,079 patients (857 ViV, 222 ViR; mean age 73.5 years ± 12.5; 40.8% male) from 90 centers were included. Median STS-PROM score 8.6%; median clinical follow-up 492 days [IQR 76 - 996 days]; median echocardiographic follow-up for patients that survived 1 year 772.5 days [IQR 510 - 1211.75 days]. Four-year Kaplan-Meier survival rate was 62.5% in ViV vs. 49.5% for ViR (p<0.001). Mean gradient across the mitral valve post-procedure was 5.7 ± 2.8 mmHg (≥5mmHg, 61.4% of patients). Significant residual MS occurred in 8.2% of the ViV and 12.0% of the ViR patients (p=0.09). Significant residual MR was more common in ViR patients (16.6% vs. 3.1%; p<0.001) and was associated with lower survival at 4 years (35.1% vs. 61.6%; p=0.02). The rates of MVARC-defined device success were low for both procedures (39.4% total; 32.0% ViR vs. 41.3% ViV; p=0.01), mostly related to having post-procedural mean gradient ≥5mmHg. Correlates for residual MS were smaller true internal diameter, younger age and larger body mass index. The only correlate for residual MR was ViR. Significant residual MS (SHR 4.67; 95% CI 1.74 - 12.56; p=0.002) and significant residual MR (SHR 7.88; 95% CI 2.88 - 21.53; p<0.001) were both independently associated with repeat mitral valve replacement.
Significant residual MS and/or MR were not infrequent after mitral ViV and ViR procedures and were both associated with a need for repeat valve replacement. Strategies to improve post-procedural hemodynamics in mitral ViV and ViR should be further explored.
- Language
-
- English
- Open access status
- green
- Identifiers
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- DOI 10.1161/circulationaha.120.049088
- ISSN 0009-7322
- Persistent URL
- https://sonar.ch/global/documents/49153
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