Balloon-expandable versus self-expanding valves in patients with prior surgical mitral valve replacement undergoing transcatheter aortic valve replacement

Background: Pre-existing mitral prosthesis raises technical challenges for transcatheter aortic valve replacement (TAVR) but has been scarcely studied. In this work we sought to compare outcomes of patients with previous surgical mitral valve prostheses undergoing TAVR with balloon-expandable valve...

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Detalles Bibliográficos
Autores: Asmarats, Lluís, Jiménez Quevedo, Pilar, Amat Santos, Ignacio J., Ferrer Gracía, Marí Cruz, Sarnago Cebada, Fernando, Alonso Briales, Juan H., Oteo Domínguez, Juan Francisco, Serra García, Vicenç, Muntané Carol, Guillem, Vilalta, Victoria, Val, David del, Pan Álvarez Ossorio, Manuel, Torre Hernández, José María de la, García Blas, Sergio, Díez Gil, José Luís, Berenguer, Alberto, Valle Fernández, Raquel del, Navarro del Amo, Felipe, Artaiz Urdaci, Miguel, Regueiro, Ander, López Pérez, Manuel, Massó Van Roessel, Albert, Paredes Vázquez, José G., Fernández Cordón, Clara, Diarte de Miguel, José Antonio, Maneiro Melón, Nicolás, Piserra López, Alberto, Fuente, Jorge de la, Muñoz, Juan, Romaguera, Rafael, Carrillo, Xavier, Alfonso, Fernando, Alvarado, Marco, Veiga Fernández, Gabriela, Millán, Xavier, Nombela Franco, Luis, Arzamendi, Dabit
Tipo de recurso: artículo
Estado:Versión publicada
Fecha de publicación:2025
País:España
Institución:Varias* (Consorci de Biblioteques Universitáries de Catalunya, Centre de Serveis Científics i Acadèmics de Catalunya)
Repositorio:Recercat. Dipósit de la Recerca de Catalunya
OAI Identifier:oai:recercat.cat:2445/223348
Acceso en línea:https://hdl.handle.net/2445/223348
Access Level:acceso abierto
Palabra clave:Pròtesis valvulars cardíaques
Cirurgia cardiovascular
Heart valve prosthesis
Cardiovascular surgery
Descripción
Sumario:Background: Pre-existing mitral prosthesis raises technical challenges for transcatheter aortic valve replacement (TAVR) but has been scarcely studied. In this work we sought to compare outcomes of patients with previous surgical mitral valve prostheses undergoing TAVR with balloon-expandable valve (BEV) or self-expanding valve (SEV) systems. Methods: Patients from the Spanish TAVR registry with pre-existing surgical mitral prostheses were included in this investigation. The primary endpoints were Valve Academic Research Consortium-3 technical and device success, with analysis according to valve type. Transcatheter heart valve (THV) embolization, mitral valve impingement, THV performance, and pacemaker findings were also assessed. Results: A total of 243 patients were included (37% BEVs, 63% SEVs). Overall technical success was 95.9%. Thirty-day device success was higher in BEV patients (94.4% vs 85.0%, P = 0.036), mainly driven by fewer incidences of moderate residual aortic regurgitation (0% vs 5.9%, P = 0.028) and THV embolization (0% vs 3.9%, P = 0.087). BEV recipients exhibited higher mean transvalvular gradients (10.5 vs 8.1 mm Hg, P = 0.002) and lower rates of permanent pacemaker implantation (5.6% vs 15.7%, P = 0.023). There were no differences in mortality, bleeding, or readmission at 30 days. In the multivariate analysis, a mitroaortic distance of < 7 mm and lack of trans-esophageal echocardiography guidance were associated with increased device failure. Conclusions: In patients with pre-existing MV prostheses, TAVR was safe and effective regardless of the THV type. Nevertheless, the use of BEVs resulted in an increased rate of device success, driven by lesser THV embolization and residual aortic regurgitation.

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