Outcomes of transcatheter mitral valve replacement for degenerated bioprostheses, failed annuloplasty rings, and mitral annular calcification

Sung Han Yoon, Brian K. Whisenant, Sabine Bleiziffer, Victoria Delgado, Abhijeet Dhoble, Niklas Schofer, Lena Eschenbach, Eric Bansal, Dale J. Murdoch, Marco Ancona, Tobias Schmidt, Ermela Yzeiraj, Flavien Vincent, Hiroki Niikura, Won Keun Kim, Masahiko Asami, Axel Unbehaun, Sameer Hirji, Buntaro Fujita, Miriam Silaschi & 46 others Gilbert H.L. Tang, Shingo Kuwata, S. Chiu Wong, Antonio H. Frangieh, Colin M. Barker, James E. Davies, Alexander Lauten, Florian Deuschl, Luis Nombela-Franco, Rajiv Rampat, Pedro Felipe Gomes Nicz, Jean Bernard Masson, Harindra C. Wijeysundera, Horst Sievert, Daniel J. Blackman, Enrique Gutierrez-Ibanes, Daisuke Sugiyama, Tarun Chakravarty, David Hildick-Smith, Fabio Sandoli De Brito, Christoph Jensen, Christian Jung, Richard W. Smalling, Martin Arnold, Simon Redwood, Albert Markus Kasel, Francesco Maisano, Hendrik Treede, Stephan M. Ensminger, Saibal Kar, Tsuyoshi Kaneko, Thomas Pilgrim, Paul Sorajja, Eric Van Belle, Bernard D. Prendergast, Vinayak Bapat, Thomas Modine, Joachim Schofer, Christian Frerker, Joerg Kempfert, Guilherme F. Attizzani, Azeem Latib, Ulrich Schaefer, John G. Webb, Jeroen J. Bax, Raj R. Makkar

Research output: Contribution to journalArticle

22 Citations (Scopus)

Abstract

Aims: We sought to evaluate the outcomes of transcatheter mitral valve replacement (TMVR) for patients with degenerated bioprostheses [valve-in-valve (ViV)], failed annuloplasty rings [valve-in-ring (ViR)], and severe mitral annular calcification [valve-in-mitral annular calcification (ViMAC)]. Methods and results: From the TMVR multicentre registry, procedural and clinical outcomes of ViV, ViR, and ViMAC were compared according to Mitral Valve Academic Research Consortium (MVARC) criteria. A total of 521 patients with mean Society of Thoracic Surgeons score of 9.0± 7.0% underwent TMVR (322 patients with ViV, 141 with ViR, and 58 with ViMAC). Trans-septal access and the Sapien valves were used in 39.5% and 90.0%, respectively. Overall technical success was excellent at 87.1%. However, left ventricular outflow tract obstruction occurred more frequently after ViMAC compared with ViR and ViV (39.7% vs. 5.0% vs. 2.2%; P < 0.001), whereas second valve implantation was more frequent in ViR compared with ViMAC and ViV (12.1% vs. 5.2% vs. 2.5%; P< 0.001). Accordingly, technical success rate was higher after ViV compared with ViR and ViMAC (94.4% vs. 80.9% vs. 62.1%; P< 0.001). Compared with ViMAC and ViV groups, ViR group had more frequent post-procedural mitral regurgitation ≥moderate (18.4% vs. 13.8% vs. 5.6%; P< 0.001) and subsequent paravalvular leak closure (7.8% vs. 0.0% vs. 2.2%; P = 0.006). All-cause mortality was higher after ViMAC compared with ViR and ViV at 30 days (34.5% vs. 9.9% vs. 6.2%; log-rank P<0.001) and 1 year (62.8% vs. 30.6% vs. 14.0%; log-rank P< 0.001). On multivariable analysis, patients with failed annuloplasty rings and severe MAC were at increased risk of mortality after TMVR [ViR vs. ViV, hazard ratio (HR) 1.99, 95% confidence interval (CI) 1.27-3.12; P= 0.003; ViMAC vs. ViV, HR 5.29, 95% CI 3.29-8.51; P < 0.001]. Conclusion: The TMVR provided excellent outcomes for patients with degenerated bioprostheses despite high surgical risk. However, ViR and ViMAC were associated with higher rates of adverse events and mid-term mortality compared with ViV.

Original languageEnglish
Pages (from-to)441-451
Number of pages11
JournalEuropean Heart Journal
Volume40
Issue number5
DOIs
Publication statusPublished - 2019 Jan 1

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Mitral Valve Annuloplasty
Bioprosthesis
Mitral Valve
Mortality
Confidence Intervals
Ventricular Outflow Obstruction

Keywords

  • Annuloplasty ring
  • Degenerated bioprostheses
  • Mitral annular calcification
  • Mitral valve
  • Transcatheter valve implantation

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Outcomes of transcatheter mitral valve replacement for degenerated bioprostheses, failed annuloplasty rings, and mitral annular calcification. / Yoon, Sung Han; Whisenant, Brian K.; Bleiziffer, Sabine; Delgado, Victoria; Dhoble, Abhijeet; Schofer, Niklas; Eschenbach, Lena; Bansal, Eric; Murdoch, Dale J.; Ancona, Marco; Schmidt, Tobias; Yzeiraj, Ermela; Vincent, Flavien; Niikura, Hiroki; Kim, Won Keun; Asami, Masahiko; Unbehaun, Axel; Hirji, Sameer; Fujita, Buntaro; Silaschi, Miriam; Tang, Gilbert H.L.; Kuwata, Shingo; Wong, S. Chiu; Frangieh, Antonio H.; Barker, Colin M.; Davies, James E.; Lauten, Alexander; Deuschl, Florian; Nombela-Franco, Luis; Rampat, Rajiv; Nicz, Pedro Felipe Gomes; Masson, Jean Bernard; Wijeysundera, Harindra C.; Sievert, Horst; Blackman, Daniel J.; Gutierrez-Ibanes, Enrique; Sugiyama, Daisuke; Chakravarty, Tarun; Hildick-Smith, David; De Brito, Fabio Sandoli; Jensen, Christoph; Jung, Christian; Smalling, Richard W.; Arnold, Martin; Redwood, Simon; Kasel, Albert Markus; Maisano, Francesco; Treede, Hendrik; Ensminger, Stephan M.; Kar, Saibal; Kaneko, Tsuyoshi; Pilgrim, Thomas; Sorajja, Paul; Van Belle, Eric; Prendergast, Bernard D.; Bapat, Vinayak; Modine, Thomas; Schofer, Joachim; Frerker, Christian; Kempfert, Joerg; Attizzani, Guilherme F.; Latib, Azeem; Schaefer, Ulrich; Webb, John G.; Bax, Jeroen J.; Makkar, Raj R.

In: European Heart Journal, Vol. 40, No. 5, 01.01.2019, p. 441-451.

Research output: Contribution to journalArticle

Yoon, SH, Whisenant, BK, Bleiziffer, S, Delgado, V, Dhoble, A, Schofer, N, Eschenbach, L, Bansal, E, Murdoch, DJ, Ancona, M, Schmidt, T, Yzeiraj, E, Vincent, F, Niikura, H, Kim, WK, Asami, M, Unbehaun, A, Hirji, S, Fujita, B, Silaschi, M, Tang, GHL, Kuwata, S, Wong, SC, Frangieh, AH, Barker, CM, Davies, JE, Lauten, A, Deuschl, F, Nombela-Franco, L, Rampat, R, Nicz, PFG, Masson, JB, Wijeysundera, HC, Sievert, H, Blackman, DJ, Gutierrez-Ibanes, E, Sugiyama, D, Chakravarty, T, Hildick-Smith, D, De Brito, FS, Jensen, C, Jung, C, Smalling, RW, Arnold, M, Redwood, S, Kasel, AM, Maisano, F, Treede, H, Ensminger, SM, Kar, S, Kaneko, T, Pilgrim, T, Sorajja, P, Van Belle, E, Prendergast, BD, Bapat, V, Modine, T, Schofer, J, Frerker, C, Kempfert, J, Attizzani, GF, Latib, A, Schaefer, U, Webb, JG, Bax, JJ & Makkar, RR 2019, 'Outcomes of transcatheter mitral valve replacement for degenerated bioprostheses, failed annuloplasty rings, and mitral annular calcification', European Heart Journal, vol. 40, no. 5, pp. 441-451. https://doi.org/10.1093/eurheartj/ehy590
Yoon, Sung Han ; Whisenant, Brian K. ; Bleiziffer, Sabine ; Delgado, Victoria ; Dhoble, Abhijeet ; Schofer, Niklas ; Eschenbach, Lena ; Bansal, Eric ; Murdoch, Dale J. ; Ancona, Marco ; Schmidt, Tobias ; Yzeiraj, Ermela ; Vincent, Flavien ; Niikura, Hiroki ; Kim, Won Keun ; Asami, Masahiko ; Unbehaun, Axel ; Hirji, Sameer ; Fujita, Buntaro ; Silaschi, Miriam ; Tang, Gilbert H.L. ; Kuwata, Shingo ; Wong, S. Chiu ; Frangieh, Antonio H. ; Barker, Colin M. ; Davies, James E. ; Lauten, Alexander ; Deuschl, Florian ; Nombela-Franco, Luis ; Rampat, Rajiv ; Nicz, Pedro Felipe Gomes ; Masson, Jean Bernard ; Wijeysundera, Harindra C. ; Sievert, Horst ; Blackman, Daniel J. ; Gutierrez-Ibanes, Enrique ; Sugiyama, Daisuke ; Chakravarty, Tarun ; Hildick-Smith, David ; De Brito, Fabio Sandoli ; Jensen, Christoph ; Jung, Christian ; Smalling, Richard W. ; Arnold, Martin ; Redwood, Simon ; Kasel, Albert Markus ; Maisano, Francesco ; Treede, Hendrik ; Ensminger, Stephan M. ; Kar, Saibal ; Kaneko, Tsuyoshi ; Pilgrim, Thomas ; Sorajja, Paul ; Van Belle, Eric ; Prendergast, Bernard D. ; Bapat, Vinayak ; Modine, Thomas ; Schofer, Joachim ; Frerker, Christian ; Kempfert, Joerg ; Attizzani, Guilherme F. ; Latib, Azeem ; Schaefer, Ulrich ; Webb, John G. ; Bax, Jeroen J. ; Makkar, Raj R. / Outcomes of transcatheter mitral valve replacement for degenerated bioprostheses, failed annuloplasty rings, and mitral annular calcification. In: European Heart Journal. 2019 ; Vol. 40, No. 5. pp. 441-451.
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title = "Outcomes of transcatheter mitral valve replacement for degenerated bioprostheses, failed annuloplasty rings, and mitral annular calcification",
abstract = "Aims: We sought to evaluate the outcomes of transcatheter mitral valve replacement (TMVR) for patients with degenerated bioprostheses [valve-in-valve (ViV)], failed annuloplasty rings [valve-in-ring (ViR)], and severe mitral annular calcification [valve-in-mitral annular calcification (ViMAC)]. Methods and results: From the TMVR multicentre registry, procedural and clinical outcomes of ViV, ViR, and ViMAC were compared according to Mitral Valve Academic Research Consortium (MVARC) criteria. A total of 521 patients with mean Society of Thoracic Surgeons score of 9.0± 7.0{\%} underwent TMVR (322 patients with ViV, 141 with ViR, and 58 with ViMAC). Trans-septal access and the Sapien valves were used in 39.5{\%} and 90.0{\%}, respectively. Overall technical success was excellent at 87.1{\%}. However, left ventricular outflow tract obstruction occurred more frequently after ViMAC compared with ViR and ViV (39.7{\%} vs. 5.0{\%} vs. 2.2{\%}; P < 0.001), whereas second valve implantation was more frequent in ViR compared with ViMAC and ViV (12.1{\%} vs. 5.2{\%} vs. 2.5{\%}; P< 0.001). Accordingly, technical success rate was higher after ViV compared with ViR and ViMAC (94.4{\%} vs. 80.9{\%} vs. 62.1{\%}; P< 0.001). Compared with ViMAC and ViV groups, ViR group had more frequent post-procedural mitral regurgitation ≥moderate (18.4{\%} vs. 13.8{\%} vs. 5.6{\%}; P< 0.001) and subsequent paravalvular leak closure (7.8{\%} vs. 0.0{\%} vs. 2.2{\%}; P = 0.006). All-cause mortality was higher after ViMAC compared with ViR and ViV at 30 days (34.5{\%} vs. 9.9{\%} vs. 6.2{\%}; log-rank P<0.001) and 1 year (62.8{\%} vs. 30.6{\%} vs. 14.0{\%}; log-rank P< 0.001). On multivariable analysis, patients with failed annuloplasty rings and severe MAC were at increased risk of mortality after TMVR [ViR vs. ViV, hazard ratio (HR) 1.99, 95{\%} confidence interval (CI) 1.27-3.12; P= 0.003; ViMAC vs. ViV, HR 5.29, 95{\%} CI 3.29-8.51; P < 0.001]. Conclusion: The TMVR provided excellent outcomes for patients with degenerated bioprostheses despite high surgical risk. However, ViR and ViMAC were associated with higher rates of adverse events and mid-term mortality compared with ViV.",
keywords = "Annuloplasty ring, Degenerated bioprostheses, Mitral annular calcification, Mitral valve, Transcatheter valve implantation",
author = "Yoon, {Sung Han} and Whisenant, {Brian K.} and Sabine Bleiziffer and Victoria Delgado and Abhijeet Dhoble and Niklas Schofer and Lena Eschenbach and Eric Bansal and Murdoch, {Dale J.} and Marco Ancona and Tobias Schmidt and Ermela Yzeiraj and Flavien Vincent and Hiroki Niikura and Kim, {Won Keun} and Masahiko Asami and Axel Unbehaun and Sameer Hirji and Buntaro Fujita and Miriam Silaschi and Tang, {Gilbert H.L.} and Shingo Kuwata and Wong, {S. Chiu} and Frangieh, {Antonio H.} and Barker, {Colin M.} and Davies, {James E.} and Alexander Lauten and Florian Deuschl and Luis Nombela-Franco and Rajiv Rampat and Nicz, {Pedro Felipe Gomes} and Masson, {Jean Bernard} and Wijeysundera, {Harindra C.} and Horst Sievert and Blackman, {Daniel J.} and Enrique Gutierrez-Ibanes and Daisuke Sugiyama and Tarun Chakravarty and David Hildick-Smith and {De Brito}, {Fabio Sandoli} and Christoph Jensen and Christian Jung and Smalling, {Richard W.} and Martin Arnold and Simon Redwood and Kasel, {Albert Markus} and Francesco Maisano and Hendrik Treede and Ensminger, {Stephan M.} and Saibal Kar and Tsuyoshi Kaneko and Thomas Pilgrim and Paul Sorajja and {Van Belle}, Eric and Prendergast, {Bernard D.} and Vinayak Bapat and Thomas Modine and Joachim Schofer and Christian Frerker and Joerg Kempfert and Attizzani, {Guilherme F.} and Azeem Latib and Ulrich Schaefer and Webb, {John G.} and Bax, {Jeroen J.} and Makkar, {Raj R.}",
year = "2019",
month = "1",
day = "1",
doi = "10.1093/eurheartj/ehy590",
language = "English",
volume = "40",
pages = "441--451",
journal = "European Heart Journal",
issn = "0195-668X",
publisher = "Oxford University Press",
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TY - JOUR

T1 - Outcomes of transcatheter mitral valve replacement for degenerated bioprostheses, failed annuloplasty rings, and mitral annular calcification

AU - Yoon, Sung Han

AU - Whisenant, Brian K.

AU - Bleiziffer, Sabine

AU - Delgado, Victoria

AU - Dhoble, Abhijeet

AU - Schofer, Niklas

AU - Eschenbach, Lena

AU - Bansal, Eric

AU - Murdoch, Dale J.

AU - Ancona, Marco

AU - Schmidt, Tobias

AU - Yzeiraj, Ermela

AU - Vincent, Flavien

AU - Niikura, Hiroki

AU - Kim, Won Keun

AU - Asami, Masahiko

AU - Unbehaun, Axel

AU - Hirji, Sameer

AU - Fujita, Buntaro

AU - Silaschi, Miriam

AU - Tang, Gilbert H.L.

AU - Kuwata, Shingo

AU - Wong, S. Chiu

AU - Frangieh, Antonio H.

AU - Barker, Colin M.

AU - Davies, James E.

AU - Lauten, Alexander

AU - Deuschl, Florian

AU - Nombela-Franco, Luis

AU - Rampat, Rajiv

AU - Nicz, Pedro Felipe Gomes

AU - Masson, Jean Bernard

AU - Wijeysundera, Harindra C.

AU - Sievert, Horst

AU - Blackman, Daniel J.

AU - Gutierrez-Ibanes, Enrique

AU - Sugiyama, Daisuke

AU - Chakravarty, Tarun

AU - Hildick-Smith, David

AU - De Brito, Fabio Sandoli

AU - Jensen, Christoph

AU - Jung, Christian

AU - Smalling, Richard W.

AU - Arnold, Martin

AU - Redwood, Simon

AU - Kasel, Albert Markus

AU - Maisano, Francesco

AU - Treede, Hendrik

AU - Ensminger, Stephan M.

AU - Kar, Saibal

AU - Kaneko, Tsuyoshi

AU - Pilgrim, Thomas

AU - Sorajja, Paul

AU - Van Belle, Eric

AU - Prendergast, Bernard D.

AU - Bapat, Vinayak

AU - Modine, Thomas

AU - Schofer, Joachim

AU - Frerker, Christian

AU - Kempfert, Joerg

AU - Attizzani, Guilherme F.

AU - Latib, Azeem

AU - Schaefer, Ulrich

AU - Webb, John G.

AU - Bax, Jeroen J.

AU - Makkar, Raj R.

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Aims: We sought to evaluate the outcomes of transcatheter mitral valve replacement (TMVR) for patients with degenerated bioprostheses [valve-in-valve (ViV)], failed annuloplasty rings [valve-in-ring (ViR)], and severe mitral annular calcification [valve-in-mitral annular calcification (ViMAC)]. Methods and results: From the TMVR multicentre registry, procedural and clinical outcomes of ViV, ViR, and ViMAC were compared according to Mitral Valve Academic Research Consortium (MVARC) criteria. A total of 521 patients with mean Society of Thoracic Surgeons score of 9.0± 7.0% underwent TMVR (322 patients with ViV, 141 with ViR, and 58 with ViMAC). Trans-septal access and the Sapien valves were used in 39.5% and 90.0%, respectively. Overall technical success was excellent at 87.1%. However, left ventricular outflow tract obstruction occurred more frequently after ViMAC compared with ViR and ViV (39.7% vs. 5.0% vs. 2.2%; P < 0.001), whereas second valve implantation was more frequent in ViR compared with ViMAC and ViV (12.1% vs. 5.2% vs. 2.5%; P< 0.001). Accordingly, technical success rate was higher after ViV compared with ViR and ViMAC (94.4% vs. 80.9% vs. 62.1%; P< 0.001). Compared with ViMAC and ViV groups, ViR group had more frequent post-procedural mitral regurgitation ≥moderate (18.4% vs. 13.8% vs. 5.6%; P< 0.001) and subsequent paravalvular leak closure (7.8% vs. 0.0% vs. 2.2%; P = 0.006). All-cause mortality was higher after ViMAC compared with ViR and ViV at 30 days (34.5% vs. 9.9% vs. 6.2%; log-rank P<0.001) and 1 year (62.8% vs. 30.6% vs. 14.0%; log-rank P< 0.001). On multivariable analysis, patients with failed annuloplasty rings and severe MAC were at increased risk of mortality after TMVR [ViR vs. ViV, hazard ratio (HR) 1.99, 95% confidence interval (CI) 1.27-3.12; P= 0.003; ViMAC vs. ViV, HR 5.29, 95% CI 3.29-8.51; P < 0.001]. Conclusion: The TMVR provided excellent outcomes for patients with degenerated bioprostheses despite high surgical risk. However, ViR and ViMAC were associated with higher rates of adverse events and mid-term mortality compared with ViV.

AB - Aims: We sought to evaluate the outcomes of transcatheter mitral valve replacement (TMVR) for patients with degenerated bioprostheses [valve-in-valve (ViV)], failed annuloplasty rings [valve-in-ring (ViR)], and severe mitral annular calcification [valve-in-mitral annular calcification (ViMAC)]. Methods and results: From the TMVR multicentre registry, procedural and clinical outcomes of ViV, ViR, and ViMAC were compared according to Mitral Valve Academic Research Consortium (MVARC) criteria. A total of 521 patients with mean Society of Thoracic Surgeons score of 9.0± 7.0% underwent TMVR (322 patients with ViV, 141 with ViR, and 58 with ViMAC). Trans-septal access and the Sapien valves were used in 39.5% and 90.0%, respectively. Overall technical success was excellent at 87.1%. However, left ventricular outflow tract obstruction occurred more frequently after ViMAC compared with ViR and ViV (39.7% vs. 5.0% vs. 2.2%; P < 0.001), whereas second valve implantation was more frequent in ViR compared with ViMAC and ViV (12.1% vs. 5.2% vs. 2.5%; P< 0.001). Accordingly, technical success rate was higher after ViV compared with ViR and ViMAC (94.4% vs. 80.9% vs. 62.1%; P< 0.001). Compared with ViMAC and ViV groups, ViR group had more frequent post-procedural mitral regurgitation ≥moderate (18.4% vs. 13.8% vs. 5.6%; P< 0.001) and subsequent paravalvular leak closure (7.8% vs. 0.0% vs. 2.2%; P = 0.006). All-cause mortality was higher after ViMAC compared with ViR and ViV at 30 days (34.5% vs. 9.9% vs. 6.2%; log-rank P<0.001) and 1 year (62.8% vs. 30.6% vs. 14.0%; log-rank P< 0.001). On multivariable analysis, patients with failed annuloplasty rings and severe MAC were at increased risk of mortality after TMVR [ViR vs. ViV, hazard ratio (HR) 1.99, 95% confidence interval (CI) 1.27-3.12; P= 0.003; ViMAC vs. ViV, HR 5.29, 95% CI 3.29-8.51; P < 0.001]. Conclusion: The TMVR provided excellent outcomes for patients with degenerated bioprostheses despite high surgical risk. However, ViR and ViMAC were associated with higher rates of adverse events and mid-term mortality compared with ViV.

KW - Annuloplasty ring

KW - Degenerated bioprostheses

KW - Mitral annular calcification

KW - Mitral valve

KW - Transcatheter valve implantation

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U2 - 10.1093/eurheartj/ehy590

DO - 10.1093/eurheartj/ehy590

M3 - Article

VL - 40

SP - 441

EP - 451

JO - European Heart Journal

JF - European Heart Journal

SN - 0195-668X

IS - 5

ER -