Key result
Staged TAVI plus MitraClip linked to ~6% absolute improvement in 6-month LVEF.
Why the study?
Percutaneous treatment of aortic valve stenosis and mitral valve regurgitation has been recently proposed for high surgical risk patients, but experience with staged total percutaneous management is limited.
Is staged percutaneous treatment with TAVI followed by MitraClip feasible and safe in high-surgical-risk patients with aortic valve stenosis and persistent severe mitral regurgitation?
Observational (n=12)
No
Is staged percutaneous treatment with TAVI followed by MitraClip feasible and safe in high-surgical-risk patients with aortic valve stenosis and persistent severe mitral regurgitation?
Staged percutaneous treatment of aortic stenosis with TAVI followed by MitraClip for persistent mitral regurgitation is feasible, safe, and improves functional status and LV-EF in high-risk patients.
Answers are grounded in this paper and cite their sources.
Staged TAVI then MitraClip appears feasible in high-risk aorto-mitral disease; leaves open need for randomized data before wider adoption.
OBJECTIVES: To summarize our single Institution experience with staged total percutaneous management of aorto-mitral pathology. BACKGROUND: Percutaneous treatment of aortic valve stenosis (AVS) and mitral valve regurgitation (MVR) has been recently proposed for patients at high surgical risk. METHODS: Data concerning consecutive patients undergoing percutaneous transcatheter AV implantation (TAVI) followed by MV repair with MitraClip® were prospectively collected and analyzed. RESULTS: From January 2010 to February 2012 a total of 254 patients were referred to undergo TAVI in our Institution. Seventeen (6.7%) had preoperative severe MVR that remained unchanged after TAVI. Due to exacerbation of symptoms 12 patients were subsequently submitted to MV repair with the MitraClip® device. Mean age was 79 years (72-86 years), median Ambler score was 30.1 (17.2-42.6) and EuroSCORE 22.3 (10.2-48.6). Procedural success rate was 100%. Postprocedural hospitalization was 7.1 ± 2.7 and 4.6 ± 0.9 days after TAVI and MV repair, respectively. Six months follow-up echocardiography confirms improvement in LV-EF (37.2 ± 9.9 vs. 43.5 ± 10.7, P < 0.0001). No patient presents MVR exceeding grade I(+) or prosthetic aortic insufficiency > I grade and all patients experienced an improvement in functional status. CONCLUSIONS: Percutaneous treatment of AVS and MVR is feasible and safe. A tailored approach should be considered to treat firstly the AVS and subsequently the MVR when severe MV dysfunction and symptoms persist. Short-term durability of this combined percutaneous approach seems encouraging and justifies the economical burden to treat patients that have no other option.
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Kische et al. (2013) conducted an observational in Aortic valve stenosis and mitral valve regurgitation (n=12). Staged TAVI followed by MitraClip was evaluated on LV-EF at 6 months (p=<0.0001). Staged percutaneous treatment with TAVI followed by MitraClip for persistent severe mitral regurgitation achieved 100% procedural success and improved LV-EF at 6 months.
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