TY - JOUR
T1 - Early outcomes following transatrial transcatheter mitral valve replacement in patients with severe mitral annular calcification
AU - Brener, Michael I.
AU - Hamandi, Mohanad
AU - Hong, Estee
AU - Pizano, Alejandro
AU - Harloff, Morgan T.
AU - Garner, Evan F.
AU - El Sabbagh, Abdallah
AU - Kaple, Ryan K.
AU - Geirsson, Arnar
AU - Deaton, David W.
AU - Islam, Ashequl M.
AU - Veeregandham, Ramesh
AU - Bapat, Vinayak
AU - Khalique, Omar K.
AU - Ning, Yuming
AU - Kurlansky, Paul A.
AU - Grayburn, Paul A.
AU - Nazif, Tamim M.
AU - Kodali, Susheel K.
AU - Leon, Martin B.
AU - Borger, Michael A.
AU - Lee, Raymond
AU - Kohli, Keshav
AU - Yoganathan, Ajit P.
AU - Colli, Andrea
AU - Guerrero, Mayra E.
AU - Davies, James E.
AU - Eudailey, Kyle W.
AU - Kaneko, Tsuyoshi
AU - Nguyen, Tom C.
AU - Russell, Hyde
AU - Smith, Robert L.
AU - George, Isaac
N1 - Publisher Copyright:
© 2022 The American Association for Thoracic Surgery
PY - 2024/4
Y1 - 2024/4
N2 - Objective: Implantation of a transcatheter valve-in-mitral annular calcification (ViMAC) has emerged as an alternative to traditional surgical mitral valve (MV) replacement. Previous studies evaluating ViMAC aggregated transseptal, transapical, and transatrial forms of the procedure, leaving uncertainty about each technique's advantages and disadvantages. Thus, we sought to evaluate clinical outcomes specifically for transatrial ViMAC from the largest multicenter registry to-date. Methods: Patients with symptomatic MV dysfunction and severe MAC who underwent ViMAC were enrolled from 12 centers across the United States and Europe. Clinical characteristics, procedural details, and clinical outcomes were abstracted from the electronic record. The primary end point was all-cause mortality. Results: We analyzed 126 patients who underwent ViMAC (median age 76 years [interquartile range {IQR}, 70-82 years], 28.6% female, median Society of Thoracic Surgeons score 6.8% [IQR, 4.0-11.4], and median follow-up 89 days [IQR, 16-383.5]). Sixty-one (48.4%) had isolated mitral stenosis, 25 (19.8%) had isolated mitral regurgitation (MR), and 40 (31.7%) had mixed MV disease. Technical success was achieved in 119 (94.4%) patients. Thirty (23.8%) patients underwent concurrent septal myectomy, and 8 (6.3%) patients experienced left ventricular outflow tract obstruction (7/8 did not undergo myectomy). Five (4.2%) patients of 118 with postprocedure echocardiograms had greater than mild paravalvular leak. Thirty-day and 1-year all-cause mortality occurred in 16 and 33 patients, respectively. In multivariable models, moderate or greater MR at baseline was associated with increased risk of 1-year mortality (hazard ratio, 2.31; 95% confidence interval, 1.07-4.99, P = .03). Conclusions: Transatrial ViMAC is safe and feasible in this selected, male-predominant cohort. Patients with significant MR may derive less benefit from ViMAC than patients with mitral stenosis only.
AB - Objective: Implantation of a transcatheter valve-in-mitral annular calcification (ViMAC) has emerged as an alternative to traditional surgical mitral valve (MV) replacement. Previous studies evaluating ViMAC aggregated transseptal, transapical, and transatrial forms of the procedure, leaving uncertainty about each technique's advantages and disadvantages. Thus, we sought to evaluate clinical outcomes specifically for transatrial ViMAC from the largest multicenter registry to-date. Methods: Patients with symptomatic MV dysfunction and severe MAC who underwent ViMAC were enrolled from 12 centers across the United States and Europe. Clinical characteristics, procedural details, and clinical outcomes were abstracted from the electronic record. The primary end point was all-cause mortality. Results: We analyzed 126 patients who underwent ViMAC (median age 76 years [interquartile range {IQR}, 70-82 years], 28.6% female, median Society of Thoracic Surgeons score 6.8% [IQR, 4.0-11.4], and median follow-up 89 days [IQR, 16-383.5]). Sixty-one (48.4%) had isolated mitral stenosis, 25 (19.8%) had isolated mitral regurgitation (MR), and 40 (31.7%) had mixed MV disease. Technical success was achieved in 119 (94.4%) patients. Thirty (23.8%) patients underwent concurrent septal myectomy, and 8 (6.3%) patients experienced left ventricular outflow tract obstruction (7/8 did not undergo myectomy). Five (4.2%) patients of 118 with postprocedure echocardiograms had greater than mild paravalvular leak. Thirty-day and 1-year all-cause mortality occurred in 16 and 33 patients, respectively. In multivariable models, moderate or greater MR at baseline was associated with increased risk of 1-year mortality (hazard ratio, 2.31; 95% confidence interval, 1.07-4.99, P = .03). Conclusions: Transatrial ViMAC is safe and feasible in this selected, male-predominant cohort. Patients with significant MR may derive less benefit from ViMAC than patients with mitral stenosis only.
KW - mitral annular calcification
KW - mitral regurgitation
KW - mitral stenosis
KW - transatrial access
KW - transcatheter mitral valve replacement
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U2 - 10.1016/j.jtcvs.2022.07.038
DO - 10.1016/j.jtcvs.2022.07.038
M3 - Article
C2 - 36153166
AN - SCOPUS:85137671901
SN - 0022-5223
VL - 167
SP - 1263-1275.e3
JO - Journal of Thoracic and Cardiovascular Surgery
JF - Journal of Thoracic and Cardiovascular Surgery
IS - 4
ER -