Author + information
- David Biton1,
- Yoni Grossman2,
- Ariel Finkelstein3,
- Yafim Brodov2,
- Paul Fefer4,
- Israel Barbash5,
- Uri Landes6,
- Yaron Arbel3,
- Victor Guetta7 and
- Amit Segev8
- 1Tel-Aviv University, Sheba Medical Center, Tel Aviv, Israel
- 2Sheba medical center, Ramat Gan, Israel
- 3Tel Aviv Medical Center, Tel Aviv, Israel
- 4Sheba Medical Center, Kfar Saba, Israel
- 5Sheba Medical Center, Ramat Gan, Israel
- 6Rabin Medical Center, Tel Aviv, Israel
- 7Chaim Sheba medical center, Ramat-Gan, Israel
- 8Chaim Sheba Medical Center, Tel Hashomer, Israel
Data concerning Trans-catheter aortic valve replacement (TAVR) in patients with prior mitral surgery is limited, although preliminary reports appear to be encouraging. The aim of the study was to identify predictors of adverse outcomes in these patients.
Clinical, imaging and angiographic records of patients with previous mitral valve surgery who underwent TAVR in 3 Israeli tertiary hospitals were analyzed. Aorto-mitral distance and angle were obtained from reconstructed multi-sliced CT images (Figure). The primary endpoint was a composite of need for a 2nd valve, complete AV block, significant paravalvular leak (PVL), procedural mortality and ICU admission > 5 days.
Thirty-eight patients (74% women) with a mean age of 76±7 underwent TAVR. Euroscore2 and STS score were 12±9% and 6±5% respectively. Mean aorto-mitral distance was 9±1mm and aorto-mitral angle was 117±14° (n=21). Mean TAVI implantation depth was 6.1±3mm (28 balloon-expandable, 9 self-expandable, 1 mechanically-expandable). Composite endpoint occurred in 15.8% of patients, driven by need for 2nd valve (n=1), and by 3 patients that underwent valve snaring due to mitral valve impingement, complete AV block, and PVL. Mortality at 90 days and 1 year was 8% and 21% respectively. A statistically significant association (p=0.012) was found between low implantation depth and the composite end-point.
TAVR in the presence of mitral valve prosthesis adds to the complexity of TAVR. Meticulous pre-procedural anatomic assessment and patient selection are mandatory. Implantation depth of less than 8mm seems prudent.
STRUCTURAL: Valvular Disease: Aortic