Transcatheter aortic valve insertion after previous mitral valve operation

Kevin L. Greason, Gurpreet S Sandhu, Vuyisile T Nkomo, Katherine S. King, David L. Joyce, Eric E. Williamson, David Holmes

Research output: Contribution to journalArticle

6 Citations (Scopus)

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 languageEnglish (US)
JournalJournal of Thoracic and Cardiovascular Surgery
DOIs
StateAccepted/In press - Sep 11 2016

Fingerprint

Aortic Valve
Mitral Valve
Equipment and Supplies
Aortic Valve Insufficiency
Mortality
Echocardiography
Survival

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 journalArticle

Greason, Kevin L. ; Sandhu, Gurpreet S ; Nkomo, Vuyisile T ; King, Katherine S. ; Joyce, David L. ; Williamson, Eric E. ; Holmes, David. / Transcatheter aortic valve insertion after previous mitral valve operation. In: Journal of Thoracic and Cardiovascular Surgery. 2016.
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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.",
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AU - Williamson, Eric E.

AU - Holmes, David

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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.

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