Characteristics and outcomes of patients undergoing sequential Transcatheter Edge-to-edge Mitral Valve Repair and Transcatheter aortic valve replacement: A single center experience.
Presenter
Hassaan B Arshad, MD, Houston Methodist, Houston , TX
Hassaan B Arshad, MD1, Tanush Gupta, MD2, Neha Rao, MD2, Nadeen N Faza, M.D., FSCAI2, Moritz C. Wyler von Ballmoos, MD PhD MPH2, Stephen H. Little, MD2, Neal S. Kleiman, M.D.2, Michael J. Reardon, MD2 and Sachin S. Goel, M.D., FSCAI2, (1)Houston Methodist, Houston , TX, (2)Houston Methodist Hospital, Houston, TX
Keywords: TAVI/TAVR/Aortic Valve and TEER/TMVR/Mitral Valve
Background
MR is frequently concomitantly present in patients with severe AS being considered for AVR. Although definitive treatment of coexisting severe MR can potentially be beneficial, double-valve surgery has been reported to have almost 2-fold increased mortality compared with isolated AVR. An attractive approach in this setting could be combined TAVR and transcatheter mitral edge to edge repair (TEER) with the MitraClip device. Methods
We queried our institutional commercial MitraClip database from 2014-2020 (n=202) to identify all patients who underwent both TAVR+MitraClip (n=9) either as a concomitant or a staged procedure. Summary statistics of the baseline characteristics and periprocedural outcomes are presented as mean or median as appropriate for continuous variables and counts (%) for categorical variables. The key outcomes of interest are in-hospital/30-day and 1-year mortality and 30-day functional status after the second procedure (either TAVR or MitraClip). Results
A total of 9 patients underwent TAVR + MitraClip during the study period. Mean age was 83.3 years, 2 (22.2%) patients were women, and comorbidity burden was high (Table 1). Five (55.5%) patients had TAVR followed by MitraClip; whereas, 4 (44.5%) had MitraClip performed as the index procedure. There were no in-hospital or 30-day deaths and 1-year survival was 88.9%. There were significant improvements in NYHA functional class at 30-day follow-up. Conclusions
For patients with concomitant AS + MR who are at high surgical risk and have suitable anatomy for TEER+TAVR, dual transcatheter treatment is feasible and can be performed with excellent functional and clinical outcomes. 