TAVR After Prior Mitral Valve Surgery: Results from the Transcatheter Valve Therapy Registry.

Journal: 2019/October - Annals of Thoracic Surgery

ISSN: 1552-6259

DOI: 10.1016/j.athoracsur.2019.08.113

Abstract:

Due to perceived technical challenges, patients with previous surgical mitral valve repair or replacement (SMVR) have been excluded from most transcatheter aortic valve replacement (TAVR) trials. Our objective was to compare the 30-day and 1-year outcomes of TAVR in patients with and without prior SMVR.In a retrospective review of the Society of Thoracic Surgeons (STS) and American College of Cardiology (ACC) Transcatheter Valve Therapy (TVT) Registry, we compared 1,097 patients with prior SMVR to 46,327 without prior SMVR who underwent TAVR between November 2011 and September 2015 at 394 U.S. centers. Preoperative characteristics, procedural details, and clinical outcomes were analyzed.Patients with previous SMVR were younger, more often female, and had higher STS Predicted Risk of Mortality (8.6% vs. 6.8%, p<0.001). However, there was no difference in 30-day mortality (4.6% vs. 5.5%, p=0.29), myocardial infarction, stroke, re-intervention, new dialysis, or readmission. Moderate/severe paravalvular leak (PVL) at discharge was also similar (5.8% vs. 4.9%, p=0.34). At 1 year, morbidity was similar but there was a trend toward higher mortality in those with prior SMVR (20.0% vs. 17.5%, p=0.09) that was significant after adjustment (HR 1.18, p=0.04). The type of prior SMVR (repair, bioprosthetic replacement, or mechanical replacement) had no impact on 30-day or 1-year survival.Patients with prior SMVR undergoing TAVR had similar 30-day outcomes, slightly higher 1-year mortality, and no increase in early PVL compared to those without previous SMVR. Prior SMVR should not preclude TAVR in appropriately selected patients.

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