PMID- 24574441
OWN - NLM
STAT- MEDLINE
DCOM- 20150629
LR  - 20141011
IS  - 1873-734X (Electronic)
IS  - 1010-7940 (Linking)
VI  - 46
IP  - 5
DP  - 2014 Nov
TI  - Transcatheter aortic valve implantation reduces grade of concomitant mitral and 
      tricuspid valve regurgitation and pulmonary hypertension.
PG  - 818-24
LID - 10.1093/ejcts/ezu037 [doi]
AB  - OBJECTIVES: The presence of concomitant mitral (MR) or tricuspid regurgitation 
      (TR) is a common issue in patients undergoing transcatheter aortic valve 
      implantation (TAVI). The objective was (i) to analyse the outcomes of patients 
      with concomitant moderate or more severe MR, (ii) to compare the outcomes with 
      those of TAVI patients without concomitant MR and (iii) to evaluate the impact of 
      TAVI on grade of concomitant MR. METHODS: For creating a homogeneous study group, 
      the study was restricted to transapical (TA)-TAVI patients. Since 2008, 615 
      patients have undergone TAVI at our institution, 386 of these using the TA 
      approach with the Edwards SAPIEN bioprosthesis. Out of these, 116 (30.1%) 
      presented with concomitant moderate or more severe MR. Mean logistic European 
      System for Cardiac Operative Risk (EuroSCORE) was 18.1 +/- 11.5%, EuroSCORE II 5.4 
      +/- 0.7%. Intra- and post-hospital course, change in grade of MR, TR, right 
      ventricular systolic pressure (RVSP) and tricuspid annular plane systolic 
      excursion (TAPSE) were particularly analysed. Outcomes were compared with those 
      of the remaining TA-TAVI patients (n = 270). Mean follow-up time was 471 +/- 391 
      days, giving a total of 135 patient-years. RESULTS: Three patients (2.6%) died 
      during primary hospital stay. Estimated 1-, 2-, 3- and 4-year survival rates were 
      76.7, 75.6, 68.3 and 50.6% for study and 78.1, 77.8, 61.1 and 55.0% for control 
      groups, respectively. Postoperative morbidity and mortality did not differ 
      significantly from those of the control group. Postoperatively, a significant 
      reduction in MR (2.1 +/- 0.2 to 1.5 +/- 0.7; P < 0.01) and TR (1.9 +/- 0.5 to 1.5 +/- 
      0.7; P < 0.01) was observed. Likewise, RVSP decreased significantly from 46 +/- 16 
      to 39 +/- 15 mmHg (P < 0.01) and TAPSE non-significantly (21.9 +/- 7.3 to 19.5 +/- 5.5 
      mm; P = 0.07). After 3-6 months, 68.9% of the patients were at New York Heart 
      Association (NYHA) Class I or II, 25% at Class III and 6.0% downgraded to Class 
      IV. A reason for remaining in NYHA Class III or downgrading to NYHA Class IV 
      could not be detected, and particularly, there was no impact of grade of MR/TR, 
      left ventricular ejection fraction, TAPSE or right ventricular endsystolic 
      pressure (RVESP) on outcomes or NYHA class. CONCLUSION: TA-TAVI in patients with 
      concomitant moderate or more severe MR provides results comparable with those of 
      TA-TAVI in general. Concomitant MR had no significant impact on the short- and 
      mid-term outcomes. A significant reduction in MR, TR and pulmonary hypertension 
      was observed after TA-TAVI during short-term follow-up. Nonetheless, a relevant 
      number of patients did not experience an improvement in NYHA class.
CI  - (c) The Author 2014. Published by Oxford University Press on behalf of the European 
      Association for Cardio-Thoracic Surgery. All rights reserved.
FAU - Wilbring, Manuel
AU  - Wilbring M
AD  - Department of Cardiac Surgery, University Heart Center Dresden, Dresden, Germany 
      manuel.wilbring@gmail.com.
FAU - Tugtekin, Sems-Malte
AU  - Tugtekin SM
AD  - Department of Cardiac Surgery, University Heart Center Dresden, Dresden, Germany.
FAU - Ritzmann, Mike
AU  - Ritzmann M
AD  - Department of Cardiac Surgery, University Heart Center Dresden, Dresden, Germany.
FAU - Arzt, Sebastian
AU  - Arzt S
AD  - Department of Cardiac Surgery, University Heart Center Dresden, Dresden, Germany.
FAU - Schmidt, Torsten
AU  - Schmidt T
AD  - Department of Cardiac Surgery, University Heart Center Dresden, Dresden, Germany.
FAU - Matschke, Klaus
AU  - Matschke K
AD  - Department of Cardiac Surgery, University Heart Center Dresden, Dresden, Germany.
FAU - Kappert, Utz
AU  - Kappert U
AD  - Department of Cardiac Surgery, University Heart Center Dresden, Dresden, Germany.
FAU - Alexiou, Konstantin
AU  - Alexiou K
AD  - Department of Cardiac Surgery, University Heart Center Dresden, Dresden, Germany.
LA  - eng
PT  - Journal Article
DEP - 20140226
PL  - Germany
TA  - Eur J Cardiothorac Surg
JT  - European journal of cardio-thoracic surgery : official journal of the European 
      Association for Cardio-thoracic Surgery
JID - 8804069
SB  - IM
MH  - Aged
MH  - Aged, 80 and over
MH  - Female
MH  - Hemodynamics
MH  - Humans
MH  - Hypertension, Pulmonary/pathology/*physiopathology
MH  - Kaplan-Meier Estimate
MH  - Male
MH  - Mitral Valve Insufficiency/pathology/*physiopathology
MH  - Postoperative Complications/etiology
MH  - Transcatheter Aortic Valve Replacement/adverse effects/*methods/mortality
MH  - Treatment Outcome
MH  - Tricuspid Valve Insufficiency/pathology/*physiopathology
OTO - NOTNLM
OT  - Mitral regurgitation
OT  - RVESP
OT  - TAPSE
OT  - TAVI
OT  - Tricuspid regurgitation
EDAT- 2014/02/28 06:00
MHDA- 2015/06/30 06:00
CRDT- 2014/02/28 06:00
PHST- 2014/02/28 06:00 [entrez]
PHST- 2014/02/28 06:00 [pubmed]
PHST- 2015/06/30 06:00 [medline]
AID - ezu037 [pii]
AID - 10.1093/ejcts/ezu037 [doi]
PST - ppublish
SO  - Eur J Cardiothorac Surg. 2014 Nov;46(5):818-24. doi: 10.1093/ejcts/ezu037. Epub 
      2014 Feb 26.