Prevalence and Outcomes of Mitral Stenosis in Patients Undergoing Transcatheter Aortic Valve Replacement: Findings From the Society of Thoracic Surgeons/American College of Cardiology Transcatheter Valve Therapies Registry

Lee Joseph; Mohammad Bashir; Qun Xiang; Babatunde A Yerokun; Roland Albert Matsouaka; Sreekanth Vemulapalli; Samir Kapadia; Joaquin E Cigarroa; Firas Zahr

doi:10.1016/j.jcin.2018.01.245

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Prevalence and Outcomes of Mitral Stenosis in Patients Undergoing Transcatheter Aortic Valve Replacement: Findings From the Society of Thoracic Surgeons/American College of Cardiology Transcatheter Valve Therapies Registry

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Prevalence and Outcomes of Mitral Stenosis in Patients Undergoing Transcatheter Aortic Valve Replacement: Findings From the Society of Thoracic Surgeons/American College of Cardiology Transcatheter Valve Therapies Registry

Lee Joseph, Mohammad Bashir, Qun Xiang, Babatunde A Yerokun, Roland Albert Matsouaka, Sreekanth Vemulapalli, Samir Kapadia, Joaquin E Cigarroa and Firas Zahr

JACC. Cardiovascular interventions, Vol.11(7), pp.693-702

04/09/2018

DOI: 10.1016/j.jcin.2018.01.245

PMID: 29622149

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Abstract

This study sought to examine the prevalence of mitral stenosis (MS) and its impact on in-hospital and 1-year clinical outcomes among patients undergoing transcatheter aortic valve replacement (TAVR). Patients with coexisting severe aortic stenosis and MS are increasingly being considered for TAVR. The study cohort included 44,755 patients (age ≥18 years) who underwent TAVR during November 1, 2011, to September 30, 2015, and were registered in Society of Thoracic Surgeons/American College of Cardiology Transcatheter Valve Therapies (TVT) Registry. One-year outcomes were assessed by linking TVT registry data of this cohort to patient-specific Centers for Medicare & Medicaid Services administrative claims data (n = 31,453). The primary outcome was the composite of death, stroke, heart failure-related hospitalization, and mitral valve intervention at 1 year. MS was present in 11.6% of cohort (mean age, 82 years; 52% males), being severe in 2.7%. Severe MS was associated with higher in-hospital mortality rates (5.6% vs. 3.9% for nonsevere MS and 4.1% for no MS; p = 0.02). In contrast to those without MS, severe MS group had significantly higher risk for the primary outcome, mortality (1 year), and heart failure-related hospitalization (1 year) (adjusted hazard ratio: 1.2 [95% confidence interval (CI): 1.1 to 1.4], 1.2 [95% CI: 1.0 to 1.4], and 1.3 [95% CI: 1.1 to 1.5], respectively; p < 0.05 for all). Approximately one-tenth of patients undergoing TAVR have concomitant MS. Severe MS is an independent predictor of 1-year adverse clinical outcomes following TAVR. The higher risk for long-term adverse events must be considered when evaluating patients with combined aortic stenosis and MS for TAVR.

United States - epidemiology

Mitral Valve Stenosis - diagnosis

Prevalence

Humans

Male

Aortic Valve - surgery

Mitral Valve Stenosis - physiopathology

Aortic Valve Stenosis - mortality

Societies, Medical

Time Factors

Aged, 80 and over

Female

Registries

Aortic Valve Stenosis - surgery

Transcatheter Aortic Valve Replacement - adverse effects

Severity of Illness Index

Hospital Mortality

Risk Factors

Aortic Valve Stenosis - physiopathology

Aortic Valve - physiopathology

Treatment Outcome

Aortic Valve Stenosis - diagnosis

Centers for Medicare and Medicaid Services (U.S.)

Mitral Valve Stenosis - epidemiology

Administrative Claims, Healthcare

Aged

Mitral Valve Stenosis - mortality

Transcatheter Aortic Valve Replacement - mortality

Details

Title: Subtitle: Prevalence and Outcomes of Mitral Stenosis in Patients Undergoing Transcatheter Aortic Valve Replacement: Findings From the Society of Thoracic Surgeons/American College of Cardiology Transcatheter Valve Therapies Registry
Creators: Lee Joseph - Division of Cardiovascular Diseases, Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa
Mohammad Bashir - Division of Cardiothoracic Surgery, Department of Surgery, University of Iowa Carver College of Medicine, Iowa City, Iowa
Qun Xiang - Duke Clinical Research Institute, Durham, North Carolina
Babatunde A Yerokun - Duke Clinical Research Institute, Durham, North Carolina
Roland Albert Matsouaka - Duke Clinical Research Institute, Durham, North Carolina; Department of Biostatistics and Bioinformatics, Duke University, Durham, North Carolina
Sreekanth Vemulapalli - Duke Clinical Research Institute, Durham, North Carolina
Samir Kapadia - Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
Joaquin E Cigarroa - Knight Cardiovascular Institute, Oregon Health & Sciences University, Portland, Oregon
Firas Zahr - Knight Cardiovascular Institute, Oregon Health & Sciences University, Portland, Oregon. Electronic address: zahr@ohsu.edu
Resource Type: Journal article
Publication Details: JACC. Cardiovascular interventions, Vol.11(7), pp.693-702
DOI: 10.1016/j.jcin.2018.01.245
PMID: 29622149
NLM abbreviation: JACC Cardiovasc Interv
ISSN: 1936-8798
eISSN: 1876-7605
Publisher: United States
Grant note: DOI: 10.13039/100007120, name: Society of Thoracic Surgeons; DOI: 10.13039/100011949, name: Abbott Vascular; DOI: 10.13039/100004374, name: Medtronic; DOI: 10.13039/100005485, name: American College of Cardiology Foundation
Language: English
Date published: 04/09/2018
Academic Unit: Surgery; Cardiothoracic Surgery; Internal Medicine
Record Identifier: 9984051595702771

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