Abstract
Objective: There are limited data on transcatheter aortic valve insertion after previous mitral valve operation. To better understand the associated procedural risks, we reviewed our single-center experience. Methods: We retrospectively reviewed the records of 772 consecutive patients who received transcatheter aortic valve insertion from November 2008 through August 2016. There were 18 (2%) patients who had previous mitral valve operation that included valve repair in 4 patients (22%) and replacement in 14 (78%). Results: Baseline characteristics included age of 77 years (interquartile range 68, 84), female sex in 11 patients (61%), New York Heart Association functional class III/IV in 14 (78%), and Society of Thoracic Surgeons predicted risk of mortality of 7.0% (5.3, 12.0). Access was transfemoral in 14 patients (78%). Valve insertion was successful in all patients and involved a balloon expandable device in 10 (56%). No patient experienced acute mitral valve dysfunction or procedure-related mortality. Follow-up echocardiography demonstrated mean systolic aortic valve gradient of 9 mm Hg (8, 12), no grade moderate or greater aortic paravalvular regurgitation, and stable mitral valve function. Kaplan-Meier estimated survival was 90.9% ± 9.1% at 1 year. Conclusions: Transcatheter aortic valve insertion appears to be a safe and effective operation after previous mitral valve operation. Procedure success was achieved with both balloon expandable and self-expanding devices and was independent of arterial access method. Transcatheter valve insertion should not be denied strictly on the basis of a previous mitral valve operation.
| Original language | English (US) |
|---|---|
| Journal | Journal of Thoracic and Cardiovascular Surgery |
| DOIs | |
| State | Accepted/In press - Sep 11 2016 |
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Keywords
- Aortic stenosis
- Complication
- Mitral valve repair
- Mitral valve replacement
- Transcatheter aortic valve insertion
- Transcatheter aortic valve replacement
ASJC Scopus subject areas
- Surgery
- Pulmonary and Respiratory Medicine
- Cardiology and Cardiovascular Medicine
Cite this
Transcatheter aortic valve insertion after previous mitral valve operation. / Greason, Kevin L.; Sandhu, Gurpreet S; Nkomo, Vuyisile T; King, Katherine S.; Joyce, David L.; Williamson, Eric E.; Holmes, David.
In: Journal of Thoracic and Cardiovascular Surgery, 11.09.2016.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Transcatheter aortic valve insertion after previous mitral valve operation
AU - Greason, Kevin L.
AU - Sandhu, Gurpreet S
AU - Nkomo, Vuyisile T
AU - King, Katherine S.
AU - Joyce, David L.
AU - Williamson, Eric E.
AU - Holmes, David
PY - 2016/9/11
Y1 - 2016/9/11
N2 - Objective: There are limited data on transcatheter aortic valve insertion after previous mitral valve operation. To better understand the associated procedural risks, we reviewed our single-center experience. Methods: We retrospectively reviewed the records of 772 consecutive patients who received transcatheter aortic valve insertion from November 2008 through August 2016. There were 18 (2%) patients who had previous mitral valve operation that included valve repair in 4 patients (22%) and replacement in 14 (78%). Results: Baseline characteristics included age of 77 years (interquartile range 68, 84), female sex in 11 patients (61%), New York Heart Association functional class III/IV in 14 (78%), and Society of Thoracic Surgeons predicted risk of mortality of 7.0% (5.3, 12.0). Access was transfemoral in 14 patients (78%). Valve insertion was successful in all patients and involved a balloon expandable device in 10 (56%). No patient experienced acute mitral valve dysfunction or procedure-related mortality. Follow-up echocardiography demonstrated mean systolic aortic valve gradient of 9 mm Hg (8, 12), no grade moderate or greater aortic paravalvular regurgitation, and stable mitral valve function. Kaplan-Meier estimated survival was 90.9% ± 9.1% at 1 year. Conclusions: Transcatheter aortic valve insertion appears to be a safe and effective operation after previous mitral valve operation. Procedure success was achieved with both balloon expandable and self-expanding devices and was independent of arterial access method. Transcatheter valve insertion should not be denied strictly on the basis of a previous mitral valve operation.
AB - Objective: There are limited data on transcatheter aortic valve insertion after previous mitral valve operation. To better understand the associated procedural risks, we reviewed our single-center experience. Methods: We retrospectively reviewed the records of 772 consecutive patients who received transcatheter aortic valve insertion from November 2008 through August 2016. There were 18 (2%) patients who had previous mitral valve operation that included valve repair in 4 patients (22%) and replacement in 14 (78%). Results: Baseline characteristics included age of 77 years (interquartile range 68, 84), female sex in 11 patients (61%), New York Heart Association functional class III/IV in 14 (78%), and Society of Thoracic Surgeons predicted risk of mortality of 7.0% (5.3, 12.0). Access was transfemoral in 14 patients (78%). Valve insertion was successful in all patients and involved a balloon expandable device in 10 (56%). No patient experienced acute mitral valve dysfunction or procedure-related mortality. Follow-up echocardiography demonstrated mean systolic aortic valve gradient of 9 mm Hg (8, 12), no grade moderate or greater aortic paravalvular regurgitation, and stable mitral valve function. Kaplan-Meier estimated survival was 90.9% ± 9.1% at 1 year. Conclusions: Transcatheter aortic valve insertion appears to be a safe and effective operation after previous mitral valve operation. Procedure success was achieved with both balloon expandable and self-expanding devices and was independent of arterial access method. Transcatheter valve insertion should not be denied strictly on the basis of a previous mitral valve operation.
KW - Aortic stenosis
KW - Complication
KW - Mitral valve repair
KW - Mitral valve replacement
KW - Transcatheter aortic valve insertion
KW - Transcatheter aortic valve replacement
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UR - http://www.scopus.com/inward/citedby.url?scp=85018299247&partnerID=8YFLogxK
U2 - 10.1016/j.jtcvs.2017.03.118
DO - 10.1016/j.jtcvs.2017.03.118
M3 - Article
C2 - 28483264
AN - SCOPUS:85018299247
JO - Journal of Thoracic and Cardiovascular Surgery
JF - Journal of Thoracic and Cardiovascular Surgery
SN - 0022-5223
ER -