Transfemoral Aortic Valve Implantation in Patients With Severe Aortic Stenosis and Coexisting Mitral Valve Regurgitation.

Severe aortic stenosis with coexisting mitral regurgitation (MR) of various severity is a common finding. The goal of our study was to evaluate the relation between transcatheter transfemoral aortic valve implantation (TAVI) on coexisting MR and compare the outcome in MR improvement and nonimprovement groups. We retrospectively analyzed 252 patients who underwent TAVI with associated at least moderate MR between January 2018 and December 2020. Effect of changes in MR grade at discharge and 6-12 mo follow-up were compared. Echocardiography was performed at discharge in 245 patients and at follow-up in 154 patients. MR improvement was seen in 60.8% patients and nonimprovement in 39.2%. Overall survival was significantly higher in the MR improvement group (P = 0.020). There was a statistically significant effect on MR grade with a significant increase in the proportion of patients with mild MR at follow-up compared to discharge (58.4% versus 38.3%, P < 0.001). A similar positive effect was seen on left ventricular ejection fraction (LVEF) at follow-up compared to discharge (P < 0.001). LVEF in the MR improvement group was significantly higher at follow-up versus discharge (P < 0.001), but there was no statistically significant change in LVEF in the nonimprovement group at follow-up versus discharge (P < 0.722). TAVI in severe aortic stenosis with coexisting significant mitral valve regurgitation decreases MR severity in more than 60% of patients and improved LVEF as well as mortality.

Salem M ，Stankowski T ，Aboul-Hassan SS ，Muehle A ，Harnath A ，Rochor K ，Lukusa CT ，Herwig V ，Erkenov T ，Perek B ，Fritzsche D ... -  《-》

Impact of moderate or severe mitral and tricuspid valves regurgitation after transcatheter aortic valve replacement.

Tricuspid regurgitation (TR) and mitral regurgitation (MR) are common valvular conditions encountered in patients undergoing transcatheter aortic valve replacement (TAVR). This retrospective study investigates the impact of moderate or severe TR and MR on all-cause mortality in 1-year post-TAVR patients. Consecutive patients who underwent TAVR at the 3 academic tertiary care centers in our health system between 2012 and 2018 were identified. Patients were stratified into 2 groups based on valvular regurgitation severity: moderate/severe MR vs no/mild MR, and moderate/severe TR vs no/mild TR. Primary outcome was all-cause mortality at 1-year and 5-year follow up, and secondary outcome was in-hospital death. Logistic regression analysis was conducted to assess the relationship between moderate/severe MR or TR and all-cause mortality at 1-year and 5-year follow-up. We included a total of 1,071 patients who underwent TAVR with mean age 80.9 ± 8.6 years, 97% white, and 58.3% males. Moderate or severe MR group included 52 (4.88%) patients while mild or no MR group included 1,015 (95.12%) patients. There was no significant difference between both groups in TAVR procedure success rate (100% vs 97.83%, P = .283), in-hospital mortality (0 vs 1.08%, P = .450), or mortality at 1-year follow up (15.38% vs 14.09%, P = .794). At 5-year follow up, moderate/severe MR group had higher mortality (61.4% vs 49.5%, P = .046). In multivariable logistic regression analysis, moderate or severe MR did not show significant correlation with all-cause mortality at 1-year and 5-year follow up. Moderate or severe TR group included 86 (8.03%) patients while mild or no TR group included 985 (91.97%) patients. There was no difference between both groups in TAVR procedure success (98.8% vs 97.9%, P = .54) or in-hospital mortality (0% vs 1.1%, P = .33). At 1-year follow up, patients with moderate or severe TR had higher mortality (26.7% vs 13.2%, P = .001) compared to patients with mild or no TR. Same finding was noted with extended follow up at 5-years (68.3% vs 48.7%, P < .001). In multivariable cox regression analysis, moderate/severe TR was associated with higher all-cause mortality at 1-year (OR 1.94, 95% CI [01.09, 3.44], P = .023) and at 5-year (OR 1.46, 95% CI [1.092, 1.952], P = .011) follow up. Patients with combined moderate/severe MR and TR have even higher mortality compared to either moderate/severe valve regurgitation alone or mild/no valve regurgitation at 5-year follow up. At long term follow up, moderate/severe TR, but not MR, is associated with higher mortality in patients underwent TAVR. Combined moderate/severe TR and MR had even worse mortality. Careful assessment of multivalvular heart disease prior to the procedure is warranted.

Abraham B ，Suppah M ，Farina J ，Botros M ，Fath A ，Kaldas S ，Megaly M ，Chao CJ ，Arsanjani R ，Ayoub C ，Fortuin FD ，Sweeney J ，Pellikka P ，Nkomo V ，Alkhouli M ，Holmes D Jr ，Badr A ，Alsidawi S ... -  《-》

Transcatheter aortic valve implantation for combined aortic and mitral stenoses: Insights from the OCEAN-TAVI Registry.

Mitral stenosis (MS) occasionally coexists with aortic stenosis (AS). Limited data are available regarding the functional class and clinical outcomes of patients who undergo transcatheter aortic valve implantation (TAVI) for combined AS and MS. This study compared the clinical outcomes in patients with and without MS who underwent TAVI for severe AS and assessed the impact of mitral annulus calcification (MAC) severity, transmitral gradient (TMG) and mitral valve area (MVA) on outcomes in patients with combined AS and MS. We investigated patients in the OCEAN-TAVI registry who underwent TAVI. MS was defined as an MVA ≤ 1.5 cm2 or TMG ≥ 5 mmHg. The composite of all-cause death and admission for heart failure was compared between patients with and without MS. The impact of MAC, TMG and MVA on outcomes was assessed in patients with combined AS and MS. We identified 106 patients with MS (MAC 84%; TMG 6.4 ± 2.6 mmHg; MVA 1.10 ± 0.31 cm2) and 6570 without MS as controls. The MS group was older (85 ± 5 vs. 84 ± 5 years, P = 0.033), more of women (85 vs. 67%, P < 0.01), and had a higher risk of surgery (the Society of Thoracic Surgeons Mortality Score 8.7 ± 5.1 vs. 7.6 ± 5.9, P = 0.047) than the controls. In the MS group, the New York Heart Association Functional Class was 3 or 4 in 56% of the patients at baseline and 6% at 1 year after TAVI. Thirty-day mortality (2.8% vs. 1.3%, P = 0.18) and early composite outcomes (17% vs. 15%, P = 0.56) were comparable between patients with and without MS. During a median follow-up of 2.1 years, the presence of MS was associated with a higher incidence of adverse events compared with controls (adjusted hazard ratio [HR] 1.84; 95% confidence interval [CI] 1.34-2.51, P < 0.01), even on propensity score matched analysis (adjusted HR 1.91; 95% CI 1.14-3.22, P < 0.01). Moderate or severe MAC contributed to increased risk of adverse events in patients with MS (adjusted HR 2.89; 95% CI 1.20-6.99, P = 0.018), but TMG and MVA did not. In patients undergoing TAVI for severe AS, those with moderate or severe MS experienced worse outcomes after TAVI compared with those without MS. Patients with combined AS and MS sustained symptom improvement at 1-year post-TAVI. MAC severity was a useful predictor of adverse events compared with MS haemodynamics such as TMG and MVA in patients with combined AS and MS.

Kato N ，Tabata M ，Noguchi M ，Ito J ，Obunai K ，Watanabe H ，Yashima F ，Shirai S ，Tada N ，Naganuma T ，Yamawaki M ，Yamanaka F ，Ueno H ，Ohno Y ，Izumo M ，Nishina H ，Asami M ，Watanabe Y ，Yamamoto M ，Otsuka T ，Hayashida K ，OCEAN‐TAVI investigators ... -  《ESC Heart Failure》

Transcatheter Mitral Valve Repair for Multiple Valvular Heart Disease: Outcomes and Insights on Combined Aortic Insufficiency and Mitral Regurgitation.

The presence of concomitant aortic insufficiency (AI) and mitral regurgitation (MR) is common and may further accelerate cardiac dysfunction. However, there exists no US regulatory-approved transcatheter device for the treatment of AI. The effectiveness of isolated transcatheter mitral therapy in this population is not well-understood; thus, we aimed to evaluate outcomes for patients with combined AI and MR compared with isolated MR who underwent mitral transcatheter edge-to-edge repair (m-TEER). Retrospective data were obtained from the Northwell m-TEER registry. A total of 587 patients who underwent m-TEER at 4 high-volume transcatheter aortic valve replacement/transcatheter edge-to-edge repair centers within the Northwell Health system were included. All patients had severe MR and were divided into 2 groups: group 1 with ≥3+ AI (AI+) and the group 2 with <3+ AI (AI-). Echocardiographic outcomes were evaluated at 1 month. Clinical outcomes were evaluated at 1 month and 1 year. The primary end point was death or rehospitalization at 1 year. A total of 587 patients were included in the study, with 92 in the AI+ group. Baseline characteristics were similar in both groups. Approximately 2/3 of patients in the AI+ group demonstrated an improvement in AI severity after isolated mitral therapy. There was no difference in the primary outcome at 1 month or 1 year. There was also no significant difference in New York Heart Association functional class at 1 month between the groups. In conclusion, patients who underwent m-TEER with combined MR and AI (AI+ group) fared well compared with those with isolated mitral valve dysfunction (AI- group), with no discernible differences in survival, New York Heart Association class, or rehospitalization rates at 1 month or 1 year. Hence, isolated m-TEER is a reasonable treatment approach in patients with a high surgical risk with combined AI and MR.

Basman C ，Mustafa A ，Kodra A ，Wang D ，Singh P ，Paliwoda E ，Gasparis C ，Goldberg Y ，Liu S ，Wei C ，Cinelli M ，Mihelis E ，Ong C ，Trost B ，Rutkin B ，Koss E ，Maniatis G ，Wilson S ，Scheinerman J ，Kliger C ... -  《-》

SGLT2-inhibitors in diabetic patients with severe aortic stenosis and cardiac damage undergoing transcatheter aortic valve implantation (TAVI).

A substantial number of patients with severe aortic stenosis (AS) undergoing transcatheter aortic valve implantation (TAVI) experience adverse events after TAVI, with health care expenditure. We aimed to investigate cardiac remodeling and long-term outcomes in diabetic patients with severe AS, left ventricular ejection fraction (LVEF) < 50%, and extra-valvular cardiac damage (EVCD) undergoing TAVI treated with sodium-glucose cotransporter-2 inhibitors (SGLT2i) versus other glucose-lowering strategies (no-SGLT2i users). Multicenter international registry of consecutive diabetic patients with severe AS, LVEF < 50%, and EVCD undergoing TAVI. Based on glucose-lowering therapy at hospital discharge, patients were stratified in SGLT2i versus no-SGLT2i users. The primary endpoint was a composite of all-cause death and heart failure (HF)-hospitalization (major adverse cardiovascular events, MACE) at 2-year follow-up. Secondary outcomes included all-cause death, cardiovascular death, and HF hospitalization. The study population included 311 patients, among which 24% were SGLT2i users. Within 1-year after TAVI, SGLT2i users experienced a higher rate of LV recovery (p = 0.032), especially those with baseline LVEF ≤ 30% (p = 0.026), despite the lower baseline LVEF. Patients not treated with SGLT2i were more likely to progress to a worse EVCD stage over time (p = 0.018). At 2-year follow-up, SGLT2i use was associated with a lower rate of MACE, all-cause death, and HF hospitalization (p < 0.01 for all). After adjusting for confounding factors, the use of SGLT2i emerged as an independent predictor of reduced MACE (HR = 0.45; 95% CI 0.17-0.75; p = 0.007), all-cause death (HR = 0.51; 95% CI 0.25-0.98; p = 0.042) and HF-hospitalization (HR = 0.40; 95% CI 0.27-0.62; p = 0.004). In diabetic patients with severe AS, LVEF < 50%, and EVCD undergoing TAVI, the use of SGLT2i was associated with a more favorable cardiac remodeling and a reduced risk of MACE at 2-year follow-up.

Paolisso P ，Belmonte M ，Gallinoro E ，Scarsini R ，Bergamaschi L ，Portolan L ，Armillotta M ，Esposito G ，Moscarella E ，Benfari G ，Montalto C ，Shumkova M ，de Oliveira EK ，Angeli F ，Orzalkiewicz M ，Fabroni M ，Baydaroglu N ，Munafò AR ，D'Atri DO ，Casenghi M ，Scisciola L ，Barbieri M ，Marfella R ，Gragnano F ，Conte E ，Pellegrini D ，Ielasi A ，Andreini D ，Penicka M ，Oreglia JA ，Calabrò P ，Bartorelli A ，Pizzi C ，Palmerini T ，Vanderheyden M ，Saia F ，Ribichini F ，Barbato E ... -  《Cardiovascular Diabetology》