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Transcatheter aortic valve implantation for combined aortic and mitral stenoses: Insights from the OCEAN-TAVI Registry.
Kato, Nahoko; Tabata, Minoru; Noguchi, Masahiko; Ito, Joji; Obunai, Kotaro; Watanabe, Hiroyuki; Yashima, Fumiaki; Shirai, Shinichi; Tada, Norio; Naganuma, Toru; Yamawaki, Masahiro; Yamanaka, Futoshi; Ueno, Hiroshi; Ohno, Yohei; Izumo, Masaki; Nishina, Hidetaka; Asami, Masahiko; Watanabe, Yusuke; Yamamoto, Masanori; Otsuka, Toshiaki; Hayashida, Kentaro.
Affiliation
  • Kato N; Department of Cardiology, Tokyo Bay Urayasu Ichikawa Medical Center, Urayasu, Japan.
  • Tabata M; Department of Cardiovascular Surgery, Graduate School of Medicine, Juntendo University, Tokyo, Japan.
  • Noguchi M; Department of Cardiovascular surgery, Tokyo Bay Urayasu Ichikawa Medical Center, Urayasu, Japan.
  • Ito J; Department of Cardiology, Tokyo Bay Urayasu Ichikawa Medical Center, Urayasu, Japan.
  • Obunai K; Department of Cardiovascular surgery, Tokyo Bay Urayasu Ichikawa Medical Center, Urayasu, Japan.
  • Watanabe H; Department of Cardiology, Tokyo Bay Urayasu Ichikawa Medical Center, Urayasu, Japan.
  • Yashima F; Department of Cardiology, Tokyo Bay Urayasu Ichikawa Medical Center, Urayasu, Japan.
  • Shirai S; Department of Cardiology, Saiseikai Utsunomiya Hospital, Utsunomiya, Japan.
  • Tada N; Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan.
  • Naganuma T; Department of Cardiology, Sendai Kosei Hospital, Sendai, Japan.
  • Yamawaki M; Department of Cardiology, New Tokyo Hospital, Matsudo, Japan.
  • Yamanaka F; Department of Cardiology, Saiseikai Yokohama City Eastern Hospital, Yokohama, Japan.
  • Ueno H; Department of Cardiology, Shonan Kamakura General Hospital, Kamakura, Japan.
  • Ohno Y; Second Department of Internal Medicine, Toyama University Hospital, Toyama, Japan.
  • Izumo M; Department of Cardiology, Tokai University School of Medicine, Isehara, Japan.
  • Nishina H; Department of Cardiology, St. Marianna University School of Medicine, Kawasaki, Japan.
  • Asami M; Department of Cardiology, Tsukuba Medical Center Hospital, Tsukuba, Japan.
  • Watanabe Y; Division of Cardiology, Mitsui Memorial Hospital, Tokyo, Japan.
  • Yamamoto M; Department of Cardiology, Teikyo University School of Medicine, Tokyo, Japan.
  • Otsuka T; Department of Cardiology, Toyohashi Heart Center, Toyohashi, Japan.
  • Hayashida K; Department of Cardiology, Nagoya Heart Center, Nagoya, Japan.
ESC Heart Fail ; 2024 Aug 21.
Article in En | MEDLINE | ID: mdl-39167499
ABSTRACT

AIMS:

Mitral stenosis (MS) occasionally coexists with aortic stenosis (AS). Limited data are available regarding the functional class and clinical outcomes of patients who undergo transcatheter aortic valve implantation (TAVI) for combined AS and MS. This study compared the clinical outcomes in patients with and without MS who underwent TAVI for severe AS and assessed the impact of mitral annulus calcification (MAC) severity, transmitral gradient (TMG) and mitral valve area (MVA) on outcomes in patients with combined AS and MS.

METHODS:

We investigated patients in the OCEAN-TAVI registry who underwent TAVI. MS was defined as an MVA ≤ 1.5 cm2 or TMG ≥ 5 mmHg. The composite of all-cause death and admission for heart failure was compared between patients with and without MS. The impact of MAC, TMG and MVA on outcomes was assessed in patients with combined AS and MS.

RESULTS:

We identified 106 patients with MS (MAC 84%; TMG 6.4 ± 2.6 mmHg; MVA 1.10 ± 0.31 cm2) and 6570 without MS as controls. The MS group was older (85 ± 5 vs. 84 ± 5 years, P = 0.033), more of women (85 vs. 67%, P < 0.01), and had a higher risk of surgery (the Society of Thoracic Surgeons Mortality Score 8.7 ± 5.1 vs. 7.6 ± 5.9, P = 0.047) than the controls. In the MS group, the New York Heart Association Functional Class was 3 or 4 in 56% of the patients at baseline and 6% at 1 year after TAVI. Thirty-day mortality (2.8% vs. 1.3%, P = 0.18) and early composite outcomes (17% vs. 15%, P = 0.56) were comparable between patients with and without MS. During a median follow-up of 2.1 years, the presence of MS was associated with a higher incidence of adverse events compared with controls (adjusted hazard ratio [HR] 1.84; 95% confidence interval [CI] 1.34-2.51, P < 0.01), even on propensity score matched analysis (adjusted HR 1.91; 95% CI 1.14-3.22, P < 0.01). Moderate or severe MAC contributed to increased risk of adverse events in patients with MS (adjusted HR 2.89; 95% CI 1.20-6.99, P = 0.018), but TMG and MVA did not.

CONCLUSIONS:

In patients undergoing TAVI for severe AS, those with moderate or severe MS experienced worse outcomes after TAVI compared with those without MS. Patients with combined AS and MS sustained symptom improvement at 1-year post-TAVI. MAC severity was a useful predictor of adverse events compared with MS haemodynamics such as TMG and MVA in patients with combined AS and MS.
Key words

Full text: 1 Collection: 01-internacional Database: MEDLINE Language: En Journal: ESC Heart Fail Year: 2024 Document type: Article Affiliation country: Japan

Full text: 1 Collection: 01-internacional Database: MEDLINE Language: En Journal: ESC Heart Fail Year: 2024 Document type: Article Affiliation country: Japan