Transcatheter aortic valve implantation for combined aortic and mitral stenoses: Insights from the OCEAN‐TAVI Registry
Abstract Aims Mitral stenosis (MS) occasionally coexists with aortic stenosis (AS). Limited data are available regarding the functional class and clinical outcomes of patients who undergo transcatheter aortic valve implantation (TAVI) for combined AS and MS. This study compared the clinical outcomes...
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| Format: | Article |
| Language: | English |
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Wiley
2024-12-01
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| Series: | ESC Heart Failure |
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| Online Access: | https://doi.org/10.1002/ehf2.15030 |
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| author | Nahoko Kato Minoru Tabata Masahiko Noguchi Joji Ito Kotaro Obunai Hiroyuki Watanabe Fumiaki Yashima Shinichi Shirai Norio Tada Toru Naganuma Masahiro Yamawaki Futoshi Yamanaka Hiroshi Ueno Yohei Ohno Masaki Izumo Hidetaka Nishina Masahiko Asami Yusuke Watanabe Masanori Yamamoto Toshiaki Otsuka Kentaro Hayashida the OCEAN‐TAVI investigators |
| author_facet | Nahoko Kato Minoru Tabata Masahiko Noguchi Joji Ito Kotaro Obunai Hiroyuki Watanabe Fumiaki Yashima Shinichi Shirai Norio Tada Toru Naganuma Masahiro Yamawaki Futoshi Yamanaka Hiroshi Ueno Yohei Ohno Masaki Izumo Hidetaka Nishina Masahiko Asami Yusuke Watanabe Masanori Yamamoto Toshiaki Otsuka Kentaro Hayashida the OCEAN‐TAVI investigators |
| author_sort | Nahoko Kato |
| collection | DOAJ |
| description | Abstract Aims Mitral stenosis (MS) occasionally coexists with aortic stenosis (AS). Limited data are available regarding the functional class and clinical outcomes of patients who undergo transcatheter aortic valve implantation (TAVI) for combined AS and MS. This study compared the clinical outcomes in patients with and without MS who underwent TAVI for severe AS and assessed the impact of mitral annulus calcification (MAC) severity, transmitral gradient (TMG) and mitral valve area (MVA) on outcomes in patients with combined AS and MS. Methods We investigated patients in the OCEAN‐TAVI registry who underwent TAVI. MS was defined as an MVA ≤ 1.5 cm2 or TMG ≥ 5 mmHg. The composite of all‐cause death and admission for heart failure was compared between patients with and without MS. The impact of MAC, TMG and MVA on outcomes was assessed in patients with combined AS and MS. Results We identified 106 patients with MS (MAC 84%; TMG 6.4 ± 2.6 mmHg; MVA 1.10 ± 0.31 cm2) and 6570 without MS as controls. The MS group was older (85 ± 5 vs. 84 ± 5 years, P = 0.033), more of women (85 vs. 67%, P < 0.01), and had a higher risk of surgery (the Society of Thoracic Surgeons Mortality Score 8.7 ± 5.1 vs. 7.6 ± 5.9, P = 0.047) than the controls. In the MS group, the New York Heart Association Functional Class was 3 or 4 in 56% of the patients at baseline and 6% at 1 year after TAVI. Thirty‐day mortality (2.8% vs. 1.3%, P = 0.18) and early composite outcomes (17% vs. 15%, P = 0.56) were comparable between patients with and without MS. During a median follow‐up of 2.1 years, the presence of MS was associated with a higher incidence of adverse events compared with controls (adjusted hazard ratio [HR] 1.84; 95% confidence interval [CI] 1.34–2.51, P < 0.01), even on propensity score matched analysis (adjusted HR 1.91; 95% CI 1.14–3.22, P < 0.01). Moderate or severe MAC contributed to increased risk of adverse events in patients with MS (adjusted HR 2.89; 95% CI 1.20–6.99, P = 0.018), but TMG and MVA did not. Conclusions In patients undergoing TAVI for severe AS, those with moderate or severe MS experienced worse outcomes after TAVI compared with those without MS. Patients with combined AS and MS sustained symptom improvement at 1‐year post‐TAVI. MAC severity was a useful predictor of adverse events compared with MS haemodynamics such as TMG and MVA in patients with combined AS and MS. |
| format | Article |
| id | doaj-art-081d0fac2d3b4ae7b0d035483422d669 |
| institution | Kabale University |
| issn | 2055-5822 |
| language | English |
| publishDate | 2024-12-01 |
| publisher | Wiley |
| record_format | Article |
| series | ESC Heart Failure |
| spelling | doaj-art-081d0fac2d3b4ae7b0d035483422d6692024-12-11T01:57:00ZengWileyESC Heart Failure2055-58222024-12-011164257426610.1002/ehf2.15030Transcatheter aortic valve implantation for combined aortic and mitral stenoses: Insights from the OCEAN‐TAVI RegistryNahoko Kato0Minoru Tabata1Masahiko Noguchi2Joji Ito3Kotaro Obunai4Hiroyuki Watanabe5Fumiaki Yashima6Shinichi Shirai7Norio Tada8Toru Naganuma9Masahiro Yamawaki10Futoshi Yamanaka11Hiroshi Ueno12Yohei Ohno13Masaki Izumo14Hidetaka Nishina15Masahiko Asami16Yusuke Watanabe17Masanori Yamamoto18Toshiaki Otsuka19Kentaro Hayashida20the OCEAN‐TAVI investigatorsDepartment of Cardiology Tokyo Bay Urayasu Ichikawa Medical Center Urayasu JapanDepartment of Cardiovascular Surgery, Graduate School of Medicine Juntendo University Tokyo JapanDepartment of Cardiology Tokyo Bay Urayasu Ichikawa Medical Center Urayasu JapanDepartment of Cardiovascular surgery Tokyo Bay Urayasu Ichikawa Medical Center Urayasu JapanDepartment of Cardiology Tokyo Bay Urayasu Ichikawa Medical Center Urayasu JapanDepartment of Cardiology Tokyo Bay Urayasu Ichikawa Medical Center Urayasu JapanDepartment of Cardiology Saiseikai Utsunomiya Hospital Utsunomiya JapanDepartment of Cardiology Kokura Memorial Hospital Kitakyushu JapanDepartment of Cardiology Sendai Kosei Hospital Sendai JapanDepartment of Cardiology New Tokyo Hospital Matsudo JapanDepartment of Cardiology Saiseikai Yokohama City Eastern Hospital Yokohama JapanDepartment of Cardiology Shonan Kamakura General Hospital Kamakura JapanSecond Department of Internal Medicine Toyama University Hospital Toyama JapanDepartment of Cardiology Tokai University School of Medicine Isehara JapanDepartment of Cardiology St. Marianna University School of Medicine Kawasaki JapanDepartment of Cardiology Tsukuba Medical Center Hospital Tsukuba JapanDivision of Cardiology Mitsui Memorial Hospital Tokyo JapanDepartment of Cardiology Teikyo University School of Medicine Tokyo JapanDepartment of Cardiology Toyohashi Heart Center Toyohashi JapanDepartment of Hygiene and Public Health Nippon Medical School Tokyo JapanDepartment of Cardiology Keio University School of Medicine Tokyo JapanAbstract Aims Mitral stenosis (MS) occasionally coexists with aortic stenosis (AS). Limited data are available regarding the functional class and clinical outcomes of patients who undergo transcatheter aortic valve implantation (TAVI) for combined AS and MS. This study compared the clinical outcomes in patients with and without MS who underwent TAVI for severe AS and assessed the impact of mitral annulus calcification (MAC) severity, transmitral gradient (TMG) and mitral valve area (MVA) on outcomes in patients with combined AS and MS. Methods We investigated patients in the OCEAN‐TAVI registry who underwent TAVI. MS was defined as an MVA ≤ 1.5 cm2 or TMG ≥ 5 mmHg. The composite of all‐cause death and admission for heart failure was compared between patients with and without MS. The impact of MAC, TMG and MVA on outcomes was assessed in patients with combined AS and MS. Results We identified 106 patients with MS (MAC 84%; TMG 6.4 ± 2.6 mmHg; MVA 1.10 ± 0.31 cm2) and 6570 without MS as controls. The MS group was older (85 ± 5 vs. 84 ± 5 years, P = 0.033), more of women (85 vs. 67%, P < 0.01), and had a higher risk of surgery (the Society of Thoracic Surgeons Mortality Score 8.7 ± 5.1 vs. 7.6 ± 5.9, P = 0.047) than the controls. In the MS group, the New York Heart Association Functional Class was 3 or 4 in 56% of the patients at baseline and 6% at 1 year after TAVI. Thirty‐day mortality (2.8% vs. 1.3%, P = 0.18) and early composite outcomes (17% vs. 15%, P = 0.56) were comparable between patients with and without MS. During a median follow‐up of 2.1 years, the presence of MS was associated with a higher incidence of adverse events compared with controls (adjusted hazard ratio [HR] 1.84; 95% confidence interval [CI] 1.34–2.51, P < 0.01), even on propensity score matched analysis (adjusted HR 1.91; 95% CI 1.14–3.22, P < 0.01). Moderate or severe MAC contributed to increased risk of adverse events in patients with MS (adjusted HR 2.89; 95% CI 1.20–6.99, P = 0.018), but TMG and MVA did not. Conclusions In patients undergoing TAVI for severe AS, those with moderate or severe MS experienced worse outcomes after TAVI compared with those without MS. Patients with combined AS and MS sustained symptom improvement at 1‐year post‐TAVI. MAC severity was a useful predictor of adverse events compared with MS haemodynamics such as TMG and MVA in patients with combined AS and MS.https://doi.org/10.1002/ehf2.15030mitral stenosismitral annulus calcificationaortic stenosistranscatheter aortic valve implantation |
| spellingShingle | Nahoko Kato Minoru Tabata Masahiko Noguchi Joji Ito Kotaro Obunai Hiroyuki Watanabe Fumiaki Yashima Shinichi Shirai Norio Tada Toru Naganuma Masahiro Yamawaki Futoshi Yamanaka Hiroshi Ueno Yohei Ohno Masaki Izumo Hidetaka Nishina Masahiko Asami Yusuke Watanabe Masanori Yamamoto Toshiaki Otsuka Kentaro Hayashida the OCEAN‐TAVI investigators Transcatheter aortic valve implantation for combined aortic and mitral stenoses: Insights from the OCEAN‐TAVI Registry ESC Heart Failure mitral stenosis mitral annulus calcification aortic stenosis transcatheter aortic valve implantation |
| title | Transcatheter aortic valve implantation for combined aortic and mitral stenoses: Insights from the OCEAN‐TAVI Registry |
| title_full | Transcatheter aortic valve implantation for combined aortic and mitral stenoses: Insights from the OCEAN‐TAVI Registry |
| title_fullStr | Transcatheter aortic valve implantation for combined aortic and mitral stenoses: Insights from the OCEAN‐TAVI Registry |
| title_full_unstemmed | Transcatheter aortic valve implantation for combined aortic and mitral stenoses: Insights from the OCEAN‐TAVI Registry |
| title_short | Transcatheter aortic valve implantation for combined aortic and mitral stenoses: Insights from the OCEAN‐TAVI Registry |
| title_sort | transcatheter aortic valve implantation for combined aortic and mitral stenoses insights from the ocean tavi registry |
| topic | mitral stenosis mitral annulus calcification aortic stenosis transcatheter aortic valve implantation |
| url | https://doi.org/10.1002/ehf2.15030 |
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