The Effect of Mixed Aortic Valve Disease in Clinical Outcomes After Transcatheter Aortic Valve Replacement

Stathogiannis, Konstantinos; Toutouzas, Konstantinos; Drakopoulou, Maria; Michelongona, Archontoula; Synetos, Αndreas; Latsios, George; Trantalis, George; Kaitozis, Odysseas; Aggeli, Constantina; Tsiamis, Eleftherios; Tousoulis, Dimitris

doi:10.1016/s0735-1097(17)34612-0

Cited by 4 publications

(2 citation statements)

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“… 7 , 10 Clinical outcomes after TAVR in patients with MAVD are inconsistent in previous studies. 17 , 22 Current guidelines recommend treatment for MAVD according to the predominant lesion. When the severity of both lesions is balanced, the indication for intervention should be based on symptoms and objective consequences.…”

Section: Discussionmentioning

confidence: 99%

Assess the Outcomes of Transcatheter Aortic Valve Replacement in Bicuspid Valve with Mixed Disease versus Predominant Aortic Stenosis

Wang,

Hu,

Luo

et al. 2024

CIA

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Purpose In mixed aortic valve disease (MAVD), the results of transcatheter aortic valve replacement (TAVR) are conflicting. There is limited data on the outcomes of TAVR in patients with bicuspid aortic valve (BAV) and MAVD. The objective of this study is to compare outcomes after TAVR in BAV patients with MAVD and predominant aortic stenosis (PAS). Patients and Methods Patients with BAV who underwent TAVR between January 2016 and April 2023 were included. The primary outcome was device success. The secondary endpoints were periprocedural mortality and other complications as defined by the Valve Academic Research Consortium-3 (VARC-3). Propensity score matching was used to minimize potential confounding. Results A total of 262 patients were included in this study, 83 of whom had MAVD. The median age was 72 years, and 55.7% were male. The baseline comorbidity risk files were comparable between the two groups. Patients with MAVD had more mitral regurgitation, tricuspid regurgitation and pulmonary hypertension, larger annular and left ventricular outflow tract dimensions, and more severe calcification than PAS. In the unmatched population, MAVD patients had similar device success rate (69.9% vs 79.9%, P =0.075) and 30-day mortality (3.6% vs 3.4%, P =1) compared to PAS. Propensity score matching resulted in 66 patient pairs. Device success rate were still comparable in the matched population. Other clinical outcomes, including stroke, bleeding (type 2–4), major vascular complications, acute kidney injury (stage 2–4) and permanent pacemaker implantation, were comparable between the two groups. Multivariable logistic regression analysis did not show MAVD to be an independent negative predictor of device success. At one year, survival was similar between patients with MAVD and those with PAS. Conclusion For the bicuspid valve, patients with MAVD had a more challenging anatomy. MAVD patients associated with comparable 30-day clinical outcomes after TAVR compared to PAS patients in patients with BAV.

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Section: Discussionmentioning

confidence: 99%

Assess the Outcomes of Transcatheter Aortic Valve Replacement in Bicuspid Valve with Mixed Disease versus Predominant Aortic Stenosis

Wang,

Hu,

Luo

et al. 2024

CIA

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“…Up to 20% of patients referred for TAVI have mixed AS/AR,34 and while the majority of studies have shown non-inferior or superior survival of patients with mixed AS/AR versus patients with isolated AS, one study reported increased mortality in patients with mixed AS/AR (table 3). 34 41–46 Of importance, the mixed survival benefit of TAVI in mixed AS/AR occurs despite consistent findings of higher rates of paravalvular regurgitation (15.5% vs 6.7%, p=0.004) and lower rates of device success (81.0% vs 88.9%, p=0.027) in patients with mixed AS/AR 34 47. The mechanism by which mixed AS/AR confers a potential benefit in TAVI is postulated to be due to increased tolerance of paravalvular regurgitation, as among patients with paravalvular regurgitation those who had mixed AS/AR had better survival 44.…”

Section: Managementmentioning

confidence: 99%

Mixed aortic stenosis and regurgitation: a clinical conundrum

Nedadur

Belzile

Farrell

et al. 2022

Heart

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Mixed aortic stenosis (AS) and aortic regurgitation (AR) is the most frequent concomitant valve disease worldwide and represents a heterogeneous population ranging from mild AS with severe AR to mild AR with severe AS. About 6.8% of patients with at least moderate AS will also have moderate or greater AR, and 17.9% of patients with at least moderate AR will suffer from moderate or greater AS. Interest in mixed AS/AR has increased, with studies demonstrating that patients with moderate mixed AS/AR have similar outcomes to those with isolated severe AS. The diagnosis and quantification of mixed AS/AR severity are predominantly echocardiography-based, but the combined lesions lead to significant limitations in the assessment. Aortic valve peak velocity is the best parameter to evaluate the combined haemodynamic impact of both lesions, with a peak velocity greater than 4.0 m/s suggesting severe mixed AS/AR. Moreover, symptoms, increased left ventricular wall thickness and filling pressures, and abnormal left ventricular global longitudinal strain likely identify high-risk patients who may benefit from closer follow-up. Although guidelines recommend interventions based on the predominant lesion, some patients could potentially benefit from earlier intervention. Once a patient is deemed to require intervention, for patients receiving transcatheter valves, the presence of mixed AS/AR could confer benefit to those at high risk of paravalvular leak. Overall, the current approach of managing patients based on the dominant lesion might be too reductionist and a more holistic approach including biomarkers and multimodality imaging cardiac remodelling and inflammation data might be more appropriate.

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Outcomes of Transcatheter Aortic Valve Replacement in Patients With Concomitant Aortic Regurgitation

Yousef¹,

Bianco²,

Kliner³

et al. 2023

The Annals of Thoracic Surgery

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The Effect of Mixed Aortic Valve Disease in Clinical Outcomes After Transcatheter Aortic Valve Replacement

Cited by 4 publications

References 0 publications

Assess the Outcomes of Transcatheter Aortic Valve Replacement in Bicuspid Valve with Mixed Disease versus Predominant Aortic Stenosis

Assess the Outcomes of Transcatheter Aortic Valve Replacement in Bicuspid Valve with Mixed Disease versus Predominant Aortic Stenosis

Mixed aortic stenosis and regurgitation: a clinical conundrum

Outcomes of Transcatheter Aortic Valve Replacement in Patients With Concomitant Aortic Regurgitation

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