Procedural and 30-Day Outcomes of Patients Undergoing Transcatheter Aortic and Mitral Valve Replacements
Zajarias A, Babaliaros V, Kodali S, McCabe J, and Eng M. Procedural and 30-Day Outcomes of Patients Undergoing Transcatheter Aortic and Mitral Valve Replacements. J Am Coll Cardiol 2019; 74(13):B434.
J Am Coll Cardiol
Background: Transcatheter aortic valve replacement was originally described for the treatment of severe single-valve disease. Advances in technology have opened treatment options for patients with multivalvular pathology (aortic and mitral) with the SAPIEN XT and SAPIEN 3 prostheses. This study describes the procedural and 30-day outcomes of patients that underwent transcatheter aortic valve replacement and transcatheter mitral valve procedures (valve in valve [ViV], valve in ring [ViR]), and valve in mitral annulus calcification [MAC]) in a staged or concomitant fashion using the SAPIEN 3 and SAPIEN XT prosthetic valves. Methods: A retrospective analysis of TVT Registry including patients undergoing transcatheter aortic valve replacement for severe native aortic stenosis and bioprosthetic valve degeneration who also underwent therapy for the mitral valve (ViR, ViV, and valve in MAC) using the SAPIEN 3 and SAPIEN XT valves from August 6, 2014, to November 30, 2018, were included in the analysis. Procedural and 30-day outcomes were analyzed. Results: A total of 135 patients were included in the registry. They were primarily female (81 of 135) with a mean age of 73 ± 11 years and were all considered symptomatic and high risk due to their comorbidities. The type of procedure performed is described in Table 1. Device success was seen in 95.5% (127 of 133) with no surgical conversions. Procedures were performed in a staged 32% (43 of 135) or concomitant manner 68% (92 of 135), with median time between procedures of 183 days. The 30-day mortality was observed in 12.2%, stroke in 3.2%, life-threatening bleeding in 0.9%, and VARC safety events were seen in 18.3% (Table). [Figure presented] Conclusion: Transcatheter treatment of aortic and mitral valve disease is feasible in high-risk patients. Patient selection and procedural timing may influence survival. A direct comparison to surgical treatment of a similar population is warranted to determine patient outcomes.