Cardiac damage and quality of life after aortic valve replacement in the PARTNER trials

BACKGROUND The extent of extravalvular cardiac damage is associated with increased risk of adverse events among patients with severe aortic stenosis undergoing aortic valve replacement (AVR). OBJECTIVES The goal was to describe the association of cardiac damage on health status before and after AVR. METHODS Patients from the PARTNER (Placement of Aortic Transcatheter Valves) 2 and 3 trials were pooled and classified by echocardiographic cardiac damage stage at baseline and 1 year as previously described (stage 0-4). We examined the association between baseline cardiac damage and 1-year health status (assessed by the Kansas City Cardiomyopathy Questionnaire Overall Score [KCCQ-OS]). RESULTS Among 1,974 patients (794 surgical AVR, 1,180 transcatheter AVR), the extent of cardiac damage at baseline was associated with lower KCCQ scores both at baseline and at 1 year after AVR (P = 10 points) at 1 year (stages 0-4: 10.6% vs 19.6% vs 29.0% vs 44.7% vs 39.8%; P = 1 stage thorn 26.8 [95% CI: 24.2-29.4] vs no change thorn 21.4 [95% CI: 20.0-22.7] vs deterioration of >= 1 stage thorn 17.5 [95% CI: 15.4-19.5]; P < 0.0001). CONCLUSIONS The extent of cardiac damage before AVR has an important impact on health status outcomes, both cross-sectionally and after AVR. (PARTNER II Trial: Placement of AoRTic TraNscathetER Valves II -XT Intermediate and High Risk (PII A), NCT01314313; The PARTNER II Trial: Placement of AoRTic TraNscathetER Valves -PII B [PARTNERII B], NCT02184442; PARTNER 3 Trial: Safety and Effectiveness of the SAPIEN 3 Transcatheter Heart Valve in Low Risk Patients With Aortic Stenosis [P3], NCT02675114) (J Am Coll Cardiol 2023;81:743-752) (c) 2023 by the American College of Cardiology Foundation.Radiolog

Procedural and 30-Day Outcomes of Patients Undergoing Transcatheter Aortic and Mitral Valve Replacements

Background: Transcatheter aortic valve replacement was originally described for the treatment of severe single-valve disease. Advances in technology have opened treatment options for patients with multivalvular pathology (aortic and mitral) with the SAPIEN XT and SAPIEN 3 prostheses. This study describes the procedural and 30-day outcomes of patients that underwent transcatheter aortic valve replacement and transcatheter mitral valve procedures (valve in valve [ViV], valve in ring [ViR]), and valve in mitral annulus calcification [MAC]) in a staged or concomitant fashion using the SAPIEN 3 and SAPIEN XT prosthetic valves. Methods: A retrospective analysis of TVT Registry including patients undergoing transcatheter aortic valve replacement for severe native aortic stenosis and bioprosthetic valve degeneration who also underwent therapy for the mitral valve (ViR, ViV, and valve in MAC) using the SAPIEN 3 and SAPIEN XT valves from August 6, 2014, to November 30, 2018, were included in the analysis. Procedural and 30-day outcomes were analyzed. Results: A total of 135 patients were included in the registry. They were primarily female (81 of 135) with a mean age of 73 ± 11 years and were all considered symptomatic and high risk due to their comorbidities. The type of procedure performed is described in Table 1. Device success was seen in 95.5% (127 of 133) with no surgical conversions. Procedures were performed in a staged 32% (43 of 135) or concomitant manner 68% (92 of 135), with median time between procedures of 183 days. The 30-day mortality was observed in 12.2%, stroke in 3.2%, life-threatening bleeding in 0.9%, and VARC safety events were seen in 18.3% (Table). [Figure presented] Conclusion: Transcatheter treatment of aortic and mitral valve disease is feasible in high-risk patients. Patient selection and procedural timing may influence survival. A direct comparison to surgical treatment of a similar population is warranted to determine patient outcomes

Transcatheter Pledget-Assisted Suture Tricuspid Annuloplasty (PASTA): First-in-Human Report

Background: Tricuspid regurgitation (TR) is a malignant disease with high surgical mortality. Pledget-Assisted Suture Tricuspid Annuloplasty (PASTA) is a percutaneous annular repair to create a double orifice tricuspid valve using marketed equipment. Methods: An 83-year-old man with torrential defibrillator-lead induced tricuspid regurgitation and recurrent hospital admissions with right-sided heart failure was deemed by the heart team to have no good options and was offered PASTA on a compassionate basis. The Institutional Review Board approved this retrospective communication. X-ray fluoroscopy, intracardiac echocardiography, and transesophageal echocardiography guided the procedure. Catheters directed paired coronary guidewires to septal and lateral targets on the tricuspid annulus. Guidewires were electrified to traverse the annular targets and exchanged for sutures using a crimped half-hitch knot. The sutures were buttressed with pledgets on the annulus, and drawn together and knotted. Results: Baseline annular area was 1817 mm2 (Figure 1A), and vena contracta width 22.9 mm (Figure 1C) (severe \u3e 7 mm). After PASTA, a double orifice tricuspid valve was formed at the annular level (Figure 1B). Annular area reduced to 782 mm2, and vena contracta width \u3c 1 mm (Figure 1D). The right coronary artery remained intact. Unfortunately, the annulus dehisced over the following 2 days with recurrent severe TR. The patient was discharged home and was alive at 6-month follow-up but with persistent symptoms. Conclusion: This first-in-human report is proof of principal that an annular double orifice valve can eliminate torrential TR. However, the results were short-lived due to annular dehiscence in this enormously dilated annulus. PASTA may be feasible in humans who have a smaller and less friable tricuspid annuli, treated at an earlier stage in the disease. [Figure presented

Echocardiographic findings of transcatheter mitral valve-in-valve therapy vs. Re-do surgical MVR in patients with previous mitral prosthetic valves

BACKGROUND Adequacy of echocardiographic findings and clinical outcome after transcatheter mitral valve-in-valvereplacement for degenerative bioprosthesis is not fully understood. METHODS We retrospectively identified patients who underwent mitral valve replacement via either surgical or transcatheter for degenerative mitralbioprosthesis at three US institution. We compared echocardiographic findings and clinical outcome of patientswho had mitral valve-in-valve with those of patients who underwent second surgical mitral valve replacement. RESULTS 58 patients underwent transcatheter mitral valve replacement (TMVR) and 57 patients underwent surgicalmitral valve replacement (SMVR). Mean age and the Society of Thoracic Surgeons- Predicted Risk of Mortality (STS-PROM) were significantly higher in patients with TMVR than in those with SMVR (Age 74.8±11.1years vs 65.9±14.2years, P=0.002; STS-PROM 13.6±8.2% vs 8.9±9.8%, P\u3c0.0001, respectively). Although mean transmitral pressure gradient (MPG) tended to be higher in the TMVR group (6.5±2.8 vs 5.3±2.5, P=0.03), mitral valve area (MVA) and mitralregurgitation grade at discharge were similar between the TMVR group and SMVR group (MVA 2.6±0.8 vs 3.0±1.2, P=0.47; MR (≥mild) 9.6% vs 10.3%, P=0.92, respectively), achieving similar 1-year survival rate (TMVR 83.5% vs SMVR 76.9%, P=0.23). (Figure presented) CONCLUSION Echocardiographic findings after TMVR for degenerative mitral bioprosthesis were acceptable when compared withthose after SMVR, achieving similar one-year survival between the TMVR and the SMVR group