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 - Funding Information:
Dr Brener is supported by the American College of Cardiology/Merck Research Fellowship and is a paid consultant for Artract Medical. Dr Kaple is a speaker for Abbott and has received honoraria from Edwards Lifesciences. Dr Geirsson is supported by Medtronic and Edwards Lifesciences. Dr Islam is a consultant for Edwards Lifesciences and Medtronic. Dr Bapat has served as a consultant for Medtronic, Edwards Lifesciences, 4C Medical, and Boston Scientific. Dr Khalique has received consulting fees from Edwards Lifesciences, Abbott Structural Heart, and Boston Scientific. Dr Grayburn reports research grants from Abbott Vascular, Edwards Lifesciences, Medtronic, W.L. Gore, Cardiovalve, Neochord; and is on the advisory board or received honoraria from Abbott Vascular, Edwards Lifesciences, Medtronic, W. L. Gore & Associates, Inc, and 4C Medical. Dr Nazif has received consulting or honoraria for Edwards Lifesciences. Dr Kodali has received consulting honoraria from Admedus, Meril Lifesciences, JenaValve, and Abbott Vascular; and has served on the scientific advisory board for and owns equity in Dura Biotech, MicroInterventional Devices, Thubrikar Aortic Valve, Supira, and Admedus; and has received institutional funding to Columbia University and/or the Cardiovascular Research Foundation from Edwards Lifesciences, Medtronic, Abbott Vascular, Boston Scientific, and JenaValve. Dr Leon has received institutional clinical research grants from Abbott, Boston Scientific, Edwards Lifesciences, Medtronic, and JenaValve; and served as a nonpaid chairman and part of the JenaValve steering committee. Dr Borger has received speaker honoraria and/or consulting fees to his hospital from Edwards Lifesciences, Medtronic, Abbott, and CryoLife. Dr Lee is a speaker and consultant for Abiomed. Mr Kohli has served as a consultant for Abbott Vascular. Dr Guerrero has received research grant support from Edwards Lifesciences. Dr Davies is a consultant for Edwards Lifesciences and Abbott Vascular; and is on the medical advisory board for Medtronic. Dr Kaneko is a consultant for Edwards Lifesciences, Medtronic, 4C Medical, CardioMech, and Cook Medical; and has received speaker honoraria from Abbott and Baylis. Dr Nguyen has received speaker honoraria from Edwards Lifesciences. Dr Smith has received grant support from Edwards Lifesciences; and has received speaker honoraria from Edwards Lifesciences, Abbott, and CryoLife. Dr George has received consulting fees from W. L. Gore & Associates, Inc, Vdyne, CardioMech, Mitre Medical, and Atricure. All other authors reported no conflicts of interest.
Publisher Copyright:
© 2022 The American Association for Thoracic Surgery
PY - 2022
Y1 - 2022
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
JO - Journal of Thoracic and Cardiovascular Surgery
JF - Journal of Thoracic and Cardiovascular Surgery
ER -