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Mortality not increased in patients with prosthetic mitral valves undergoing TAVR
Among patients undergoing transcatheter aortic valve replacement, those with prosthetic mitral valves do not appear to have increased mortality risk, but bleeding may be higher, new data suggest.
The registry study included 2,412 consecutive patients (mean age, 80.5 years; 49% men) who underwent TAVR at 10 centers from April 2008 to January 2017. Of these patients, 91 (3.77%) had prosthetic mitral valves. Nearly three-quarters (73.6%) of valves were mechanical, and the rest were biological. All prosthetic mitral valve interventions were performed a median of 14 years before TAVR.
Most patients (94.5%) were on long-term vitamin K inhibitor therapy and 64.8% received bridging antithrombotic therapy, the researchers reported.
The procedure was successful in 94.7% of the global population, with no significant differences in device success rate between patients with vs. without a prosthetic mitral valve. However, interaction between the TAVR prosthesis and mitral prosthesis led to embolization in 6.7% of patients. In all cases of device embolization, the distance from the aortic annulus to the prosthetic mitral valve was less than 7 mm.
Bleeding complications were also more common in patients with prosthetic mitral valves (24.2% vs. 16.1%; P = .041), including among those treated with the transfemoral approach (22.2% vs. 13.9%; P = .048).
After a median follow-up of 5 years, 26.5% of patients died. Results of this study demonstrated no significant difference in cumulative mortality between patients with vs. without a prosthetic mitral valve (31.1% vs. 33.1%; P = .636). At 1-year follow-up, however, patients with prosthetic mitral valves more often remained in NYHA functional class III or IV HF (20.8% vs. 10.8%; P = .024).
In the global cohort, independent predictors of 5-year mortality included bleeding complications (HR = 2.278; 95% CI, 1.753-2.961), prior atrial fibrillation, chronic obstructive pulmonary disease, Society of Thoracic Surgeons score and NYHA functional class. In the cohort of patients with prosthetic mitral valves, higher STS score and the use of self-expandable devices (HR = 2.695; 95% CI, 1.133-6.412) were associated with increased mortality, according to the data.
In light of their findings, the researchers noted that TAVR can be safely performed in patients with prosthetic mitral valves, but they underscored the importance of pharmacological, imaging and technical factors in optimizing outcomes. – by Melissa Foster
Disclosures: Amat-Santos reports he is an adviser for Symetis. Please see the study for all other authors’ relevant financial disclosures.