Impact of High Baseline Left Ventricular Filling Pressure on Transcatheter Aortic Valve Replacement Outcomes in Patients with Significant Mitral Annular Calcification

2019 ◽  
Vol 32 (9) ◽  
pp. 1067-1074.e1 ◽  
Author(s):  
Vien T. Truong ◽  
Wojciech Mazur ◽  
Cassady Palmer ◽  
Gregory F. Egnaczyk ◽  
Dean J. Kereiakes ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Transcatheter Aortic Valve Replacement ◽  
Left Ventricular ◽  
Filling Pressure ◽  
Mitral Annular Calcification ◽  
Transcatheter Aortic Valve ◽  
Ventricular Filling Pressure ◽  
Ventricular Filling ◽  
Annular Calcification

Left ventricular filling pressure and survival following aortic valve replacement for severe aortic stenosis

Heart ◽  
2020 ◽  
Vol 106 (11) ◽  
pp. 830-837 ◽  
Author(s):  
Jeremy J Thaden ◽  
Mahesh Balakrishnan ◽  
Jose Sanchez ◽  
Rosalyn Adigun ◽  
Vuyisile T Nkomo ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Stenosis ◽  
Aortic Valve Replacement ◽  
Severe Aortic Stenosis ◽  
Left Ventricular ◽  
Filling Pressure ◽  
Left Ventricular Filling ◽  
Left Ventricular Filling Pressure ◽  
Ventricular Filling Pressure ◽  
Ventricular Filling

ObjectiveTo determine whether echocardiography-derived left ventricular filling pressure influences survival in patients with severe aortic stenosis (AS) undergoing aortic valve replacement (AVR).MethodsWe retrospectively reviewed 1383 consecutive patients with severe AS, normal ejection fraction and interpretable filling pressure undergoing AVR. Left ventricular filling pressure was determined according to current guidelines using mitral inflow, mitral annular tissue Doppler, estimated right ventricular systolic pressure and left atrial volume index. Cox proportional hazards regression was used to assess the influence of various parameters on mortality.ResultsAge was 75±10 years and 552 (40%) were female. Left ventricular filling pressure was normal in 325 (23%), indeterminate in 463 (33%) and increased in 595 (43%). Mean follow-up was 7.3±3.7 years, and mortality was 1.2%, 4.2% and 18.9% at 30 days and 1 and 5 years, respectively. Compared with patients with normal filling pressure, patients with increased filling pressure were older (78±9 vs 70±12, p<0.001), more often female (45% vs 35%, p=0.002) and were more likely to have New York Heart Association class III–IV symptoms (35% vs 24%, p=0.004), coronary artery disease (55% vs 42%, p<0.001) and concentric left ventricular hypertrophy (63% vs 37%, p<0.001). After correction for other factors, increased left ventricular filling pressure remained an independent predictor of mortality after successful AVR (adjusted HR 1.45 (95% CI 1.16 to 1.81), p=0.005).ConclusionsPreoperative increased left ventricular filling pressure is common in patients with AS undergoing AVR and has important prognostic implications, regardless of symptom status. Future prospective studies should consider whether patients with increased filling pressure would benefit from earlier operation.

scholarly journals Does isolated mitral annular calcification in the absence of mitral valve disease affect clinical outcomes after transcatheter aortic valve replacement?

2019 ◽  
Vol 21 (5) ◽  
pp. 522-532 ◽  
Author(s):  
Taishi Okuno ◽  
Masahiko Asami ◽  
Faisal Khan ◽  
Fabien Praz ◽  
Dik Heg ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Clinical Outcomes ◽  
Valve Replacement ◽  
Mitral Valve Disease ◽  
Transcatheter Aortic Valve Replacement ◽  
Mitral Annular Calcification ◽  
Transcatheter Aortic Valve ◽  
Annular Calcification

Abstract Aims  Mitral annular calcification (MAC) has been associated with adverse outcomes in patients undergoing transcatheter aortic valve replacement (TAVR) but has been investigated in isolation of co-existent mitral regurgitation or mitral stenosis, which may represent important confounders. This study sought to investigate the effect of MAC with and without concomitant mitral valve disease (MVD) on clinical outcomes in patients treated with TAVR. Methods and results  Computed tomography (CT) and echocardiographic data in consecutive TAVR patients enrolled into a prospective registry were categorized according to presence or absence of severe MAC and significant MVD, respectively. A total of 967 patients with adequate CT and echocardiography data were included between 2007 and 2017. Severe MAC was found in 172 patients (17.8%) and associated with MVD in 87 patients (50.6%). Compared to TAVR patients without severe MAC or MVD, all-cause mortality at 1 year was significantly increased among patients with severe MAC in combination with MVD [adjusted hazard ratio (HRadj): 1.97, 95% confidence interval (CI): 1.12–3.44, P = 0.018] and patients with isolated MVD (HRadj: 2.33, 95% CI: 1.56–3.47, P &lt; 0.001), but not in patients with isolated severe MAC in the absence of MVD (HRadj: 0.52, 95% CI: 0.21–1.33, P = 0.173). Conclusion  We found no effect of isolated MAC on clinical outcomes following TAVR in patients with preserved mitral valve function. Patients with MVD had an increased risk of death at 1 year irrespective of MAC.

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