Transcatheter Mitral Valve Replacement for Degenerated Bioprosthetic Valves and Failed Annuloplasty Rings

被引：259

作者：

Yoon, Sung-Han ^{[1
]}

Whisenant, Brian K. ^{[2
]}

Bleiziffer, Sabine ^{[3
]}

Delgado, Victoria ^{[4
]}

Schofer, Niklas ^{[5
]}

Eschenbach, Lena ^{[3
]}

Fujita, Buntaro ^{[6
]}

Sharma, Rahul ^{[1
]}

Ancona, Marco ^{[7
,8
]}

Yzeiraj, Ermela ^{[9
]}

Cannata, Stefano ^{[10
]}

Barker, Colin ^{[11
]}

Davies, James E. ^{[12
]}

Frangieh, Antonio H. ^{[13
]}

Deuschl, Florian ^{[5
]}

Podlesnikar, Tomaz ^{[4
]}

Asami, Masahiko ^{[14
]}

Dhoble, Abhijeet ^{[15
]}

Chyou, Anthony ^{[16
]}

Masson, Jean-Bernard ^{[17
]}

Wijeysundera, Harindra C. ^{[18
]}

Blackman, Daniel J. ^{[19
]}

Rampat, Rajiv ^{[20
]}

Taramasso, Maurizio ^{[21
]}

Gutierrez-Ibanes, Enrique ^{[22
]}

Chakravarty, Tarun ^{[1
]}

Attizzani, Guiherme F. ^{[23
]}

Kaneko, Tsuyoshi ^{[24
]}

Wong, S. Chiu ^{[16
]}

Sievert, Horst ^{[25
]}

Nietlispach, Fabian ^{[21
]}

Hildick-Smith, David ^{[20
]}

Nombela-Franco, Luis ^{[26
]}

Conradi, Lenard ^{[27
]}

Hengstenberg, Christian ^{[13
,28
]}

Reardon, Michael J. ^{[11
]}

Kasel, Albert Markus ^{[13
]}

Redwood, Simon ^{[10
]}

Colombo, Antonio ^{[7
,8
]}

Kar, Saibal ^{[1
]}

Maisano, Francesco ^{[21
]}

Windecker, Stephan ^{[14
]}

Pilgrim, Thomas ^{[14
]}

Ensminger, Stephan M. ^{[6
]}

Prendergast, Bernard D. ^{[10
]}

Schofer, Joachim ^{[9
]}

Schaefer, Ulrich ^{[5
]}

Bax, Jeroen J. ^{[4
]}

Latib, Azeem ^{[7
,8
]}

Makkar, Raj R. ^{[1
]}

机构：

[1] Cedars Sinai Heart Inst, Dept Intervent Cardiol, Los Angeles, CA USA

[2] Intermt Heart Inst, Div Cardiovasc Dis, Salt Lake City, UT USA

[3] German Heart Ctr, Clin Cardiovasc Surg, Munich, Germany

[4] Leiden Univ, Med Ctr, Dept Cardiol, Leiden, Netherlands

[5] Univ Heart Ctr, Dept Gen & Intervent Cardiol, Hamburg, Germany

[6] Ruhr Univ Bochum, Heart & Diabet Ctr NRW, Dept Thorac & Cardiovasc Surg, Bad Oeynhausen, Germany

[7] Osped San Raffaele, EMO GVM Ctr Cuore Columbus, Intervent Cardiol Unit, Milan, Italy

[8] Osped San Raffaele, San Raffaele Sci Inst, Milan, Italy

[9] Hamburg Univ, Cardiovasc Ctr, Hamburg, Germany

[10] St Thomas Hosp, Dept Cardiol, London, England

[11] Houston Methodist DeBakey Heart & Vasc Ctr, Houston, TX USA

[12] Univ Alabama Birmingham, Div Cardiac & Thorac Surg, Birmingham, AL USA

[13] Tech Univ Munich, Deutsch Herzzentrum Munchen, Munich, Germany

[14] Bern Univ Hosp, Dept Cardiol, Bern, Switzerland

[15] Univ Texas Hlth Sci Ctr Houston, Dept Cardiol, Houston, TX 77030 USA

[16] New York Presbyterian Hosp, Greenberg Div Cardiol, Weil Cornell Med, New York, NY USA

[17] Ctr Hosp Univ Montreal, Div Cardiol, Montreal, PQ, Canada

[18] Sunnybrook Hlth Sci Ctr, Div Cardiol, Toronto, ON, Canada

[19] Leeds Teaching Hosp, Cardiol Dept, Leeds, W Yorkshire, England

[20] Brighton & Sussex Univ Hosp NHS Trust, Sussex Cardiac Ctr, Brighton, E Sussex, England

[21] Univ Hosp Zurich, Univ Heart Ctr, Zurich, Switzerland

[22] Hosp Gen Univ Gregorio Maranon, Dept Cardiol, Madrid, Spain

[23] Univ Hosp Case Med Ctr, Valve & Struct Heart Intervent Ctr, Cleveland, OH USA

[24] Brigham & Womens Hosp, Div Cardiac Surg, Boston, MA 02115 USA

[25] Cardiovasc Ctr, Dept Cardiol & Vasc Med, Frankfurt, Germany

[26] Hosp Clinicio San Carlos, Div Cardiol, Madrid, Spain

[27] Univ Heart Ctr Hamburg, Dept Cardiothorac Surg, Hamburg, Germany

[28] German Ctr Cardiovasc Res, Partner Site Munich Heart Alliance, Munich, Germany

来源：

JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY | 2017年 / 70卷 / 09期

关键词：

annuloplasty ring; degenerated bioprostheses; mitral valve; transcatheter valve implantation; CALCIFIC AORTIC-STENOSIS; TRIAL DESIGN PRINCIPLES; END-POINT DEFINITIONS; IN-VALVE; CONSENSUS DOCUMENT; HEART-VALVES; IMPLANTATION; RISK; THROMBOSIS; REPAIR;

D O I：

10.1016/j.jacc.2017.07.714

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

BACKGROUND Limited data exist regarding transcatheter mitral valve replacement (TMVR) for patients with failed mitral valve replacement and repair. OBJECTIVES This study sought to evaluate the outcomes of TMVR in patients with failed mitral bioprosthetic valves (valve-in-valve [ViV]) and annuloplasty rings (valve-in-ring [ViR]). METHODS From the TMVR multicenter registry, procedural and clinical outcomes of mitral ViV and ViR were compared according to Mitral Valve Academic Research Consortium criteria. RESULTS A total of 248 patients with mean Society of Thoracic Surgeons score of 8.9 +/- 6.8% underwent TMVR. Transseptal access and the balloon-expandable valve were used in 33.1% and 89.9%, respectively. Compared with 176 patients undergoing ViV, 72 patients undergoing ViR had lower left ventricular ejection fraction (45.6 +/- 17.4% vs. 55.3 +/- 11.1%; p < 0.001). Overall technical and device success rates were acceptable, at 92.3% and 85.5%, respectively. However, compared with the ViV group, the ViR group had lower technical success (83.3% vs. 96.0%; p = 0.001) due to more frequent second valve implantation (11.1% vs. 2.8%; p = 0.008), and lower device success (76.4% vs. 89.2%; p = 0.009) due to more frequent reintervention (16.7% vs. 7.4%; p = 0.03). Mean mitral valve gradients were similar between groups (6.4 +/- 2.3 mm Hg vs. 5.8 +/- 2.7 mm Hg; p = 0.17), whereas the ViR group had more frequent post-procedural mitral regurgitation moderate or higher (19.4% vs. 6.8%; p = 0.003). Furthermore, the ViR group had more frequent life-threatening bleeding (8.3% vs. 2.3%; p = 0.03), acute kidney injury (11.1% vs. 4.0%; p = 0.03), and subsequent lower procedural success (58.3% vs. 79.5%; p = 0.001). The 1-year all-cause mortality rate was significantly higher in the ViR group compared with the ViV group (28.7% vs. 12.6%; log-rank test, p = 0.01). On multivariable analysis, failed annuloplasty ring was independently associated with all-cause mortality (hazard ratio: 2.70; 95% confidence interval: 1.34 to 5.43; p = 0.005). CONCLUSIONS The TMVR procedure provided acceptable outcomes in high-risk patients with degenerated bioprostheses or failed annuloplasty rings, but mitral ViR was associated with higher rates of procedural complications and mid-term mortality compared with mitral ViV. (C) 2017 by the American College of Cardiology Foundation.

引用

页码：1121 / 1131

页数：11

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