Outcomes of Transcatheter Aortic Valve Replacement in Mixed Aortic Valve Disease

Johnny Chahine; Amer N Kadri; Rama D Gajulapalli; Amar Krishnaswamy; Stephanie Mick; Oscar Perez; Hassan Lak; Raunak M Nair; Bryce Montane; James Tak; E Murat Tuzcu; Brian Griffin; Lars G Svensson; Serge C Harb; Samir R Kapadia

doi:10.1016/j.jcin.2019.06.020

Outcomes of Transcatheter Aortic Valve Replacement in Mixed Aortic Valve Disease

JACC Cardiovasc Interv. 2019 Nov 25;12(22):2299-2306. doi: 10.1016/j.jcin.2019.06.020. Epub 2019 Oct 30.

Authors

Affiliations

¹ Department of Medicine, Cleveland Clinic, Cleveland, Ohio.
² Department of Cardiovascular Medicine, Aortic Valve Center, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio.
³ Department of Thoracic and Cardiovascular Surgery, Aortic Valve Center, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio.
⁴ Department of Cardiovascular Medicine, Aortic Valve Center, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio. Electronic address: kapadis@ccf.org.

PMID: 31678084
DOI: 10.1016/j.jcin.2019.06.020

Abstract

Objectives: The aim of this study was to compare outcomes after transcatheter aortic valve replacement (TAVR) in patients with pure aortic stenosis (AS) (i.e., no or trivial associated aortic regurgitation [AR]) with those in patients with AS and mild or more severe AR (i.e., mixed aortic valve disease [MAVD]).

Background: TAVR is indicated in treating patients with severe AS. Limited data exist regarding the outcomes of TAVR in patients with MAVD.

Methods: A total of 1,133 patients who underwent TAVR between January 2014 and December 2017 were included. The primary outcome was all-cause mortality. The comparison was adjusted to account for post-TAVR AR development in both groups. The secondary outcomes included composite endpoints of early safety and clinical efficacy as specified in the Valve Academic Research Consortium-2 criteria. Variables were compared using Mann-Whitney, chi-square, and Fisher exact tests, while Kaplan-Meier analyses were used to compare survival.

Results: A total of 688 patients (61%) had MAVD (median age 83 years , 43% women). Among these, 17% developed mild, 2% moderate, and <1% severe post-TAVR AR. Overall, patients with MAVD had better survival compared with patients with pure AS (p = 0.03). Among patients who developed post-TAVR AR, those in the MAVD group had better survival (p = 0.04). In contrast, in patients who did not develop post-TAVR AR, pre-TAVR AR did not improve survival (p = 0.11).

Conclusions: Patients with MAVD who underwent TAVR had better survival compared with patients with pure AS. This is explained by the better survival of patients with MAVD who developed post-TAVR AR, likely due to left ventricular adaptation to AR.

Keywords: aortic regurgitation; aortic stenosis; mixed aortic valve disease; paravalvular regurgitation; transcatheter aortic valve replacement.

Publication types

Observational Study

MeSH terms

Adaptation, Physiological
Aged
Aged, 80 and over
Aortic Valve / diagnostic imaging
Aortic Valve / physiopathology
Aortic Valve / surgery*
Aortic Valve Insufficiency / diagnostic imaging
Aortic Valve Insufficiency / mortality
Aortic Valve Insufficiency / physiopathology
Aortic Valve Insufficiency / surgery*
Aortic Valve Stenosis / diagnostic imaging
Aortic Valve Stenosis / mortality
Aortic Valve Stenosis / physiopathology
Aortic Valve Stenosis / surgery*
Cause of Death
Female
Hemodynamics
Humans
Male
Recovery of Function
Retrospective Studies
Risk Factors
Severity of Illness Index
Time Factors
Transcatheter Aortic Valve Replacement* / adverse effects
Transcatheter Aortic Valve Replacement* / instrumentation
Transcatheter Aortic Valve Replacement* / mortality
Treatment Outcome
Ventricular Function, Left