Prevalence and Outcomes of Mitral Stenosis in Patients Undergoing Transcatheter Aortic Valve Replacement: Findings From the Society of Thoracic Surgeons/American College of Cardiology Transcatheter Valve Therapies Registry

Lee Joseph, Mohammad Bashir, Qun Xiang, Babatunde A. Yerokun, Roland Albert Matsouaka, Sreekanth Vemulapalli, Samir Kapadia, Joaquin Cigarroa, Firas Zahr

Research output: Contribution to journalArticle

12 Citations (Scopus)

Abstract

Objectives: This study sought to examine the prevalence of mitral stenosis (MS) and its impact on in-hospital and 1-year clinical outcomes among patients undergoing transcatheter aortic valve replacement (TAVR). Background: Patients with coexisting severe aortic stenosis and MS are increasingly being considered for TAVR. Methods: The study cohort included 44,755 patients (age ≥18 years) who underwent TAVR during November 1, 2011, to September 30, 2015, and were registered in Society of Thoracic Surgeons/American College of Cardiology Transcatheter Valve Therapies (TVT) Registry. One-year outcomes were assessed by linking TVT registry data of this cohort to patient-specific Centers for Medicare & Medicaid Services administrative claims data (n = 31,453). The primary outcome was the composite of death, stroke, heart failure–related hospitalization, and mitral valve intervention at 1 year. Results: MS was present in 11.6% of cohort (mean age, 82 years; 52% males), being severe in 2.7%. Severe MS was associated with higher in-hospital mortality rates (5.6% vs. 3.9% for nonsevere MS and 4.1% for no MS; p = 0.02). In contrast to those without MS, severe MS group had significantly higher risk for the primary outcome, mortality (1 year), and heart failure–related hospitalization (1 year) (adjusted hazard ratio: 1.2 [95% confidence interval (CI): 1.1 to 1.4], 1.2 [95% CI: 1.0 to 1.4], and 1.3 [95% CI: 1.1 to 1.5], respectively; p < 0.05 for all). Conclusions: Approximately one-tenth of patients undergoing TAVR have concomitant MS. Severe MS is an independent predictor of 1-year adverse clinical outcomes following TAVR. The higher risk for long-term adverse events must be considered when evaluating patients with combined aortic stenosis and MS for TAVR.

Original languageEnglish (US)
Pages (from-to)693-702
Number of pages10
JournalJACC: Cardiovascular Interventions
Volume11
Issue number7
DOIs
StatePublished - Apr 9 2018

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Mitral Valve Stenosis
Registries
Therapeutics
Aortic Valve Stenosis
Confidence Intervals
Hospitalization
Transcatheter Aortic Valve Replacement
Mortality
Medicaid
Medicare
Hospital Mortality
Mitral Valve
Cohort Studies
Stroke

Keywords

  • combined aortic and mitral stenoses
  • mitral stenosis
  • transcatheter aortic valve replacement

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Prevalence and Outcomes of Mitral Stenosis in Patients Undergoing Transcatheter Aortic Valve Replacement : Findings From the Society of Thoracic Surgeons/American College of Cardiology Transcatheter Valve Therapies Registry. / Joseph, Lee; Bashir, Mohammad; Xiang, Qun; Yerokun, Babatunde A.; Matsouaka, Roland Albert; Vemulapalli, Sreekanth; Kapadia, Samir; Cigarroa, Joaquin; Zahr, Firas.

In: JACC: Cardiovascular Interventions, Vol. 11, No. 7, 09.04.2018, p. 693-702.

Research output: Contribution to journalArticle

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title = "Prevalence and Outcomes of Mitral Stenosis in Patients Undergoing Transcatheter Aortic Valve Replacement: Findings From the Society of Thoracic Surgeons/American College of Cardiology Transcatheter Valve Therapies Registry",
abstract = "Objectives: This study sought to examine the prevalence of mitral stenosis (MS) and its impact on in-hospital and 1-year clinical outcomes among patients undergoing transcatheter aortic valve replacement (TAVR). Background: Patients with coexisting severe aortic stenosis and MS are increasingly being considered for TAVR. Methods: The study cohort included 44,755 patients (age ≥18 years) who underwent TAVR during November 1, 2011, to September 30, 2015, and were registered in Society of Thoracic Surgeons/American College of Cardiology Transcatheter Valve Therapies (TVT) Registry. One-year outcomes were assessed by linking TVT registry data of this cohort to patient-specific Centers for Medicare & Medicaid Services administrative claims data (n = 31,453). The primary outcome was the composite of death, stroke, heart failure–related hospitalization, and mitral valve intervention at 1 year. Results: MS was present in 11.6{\%} of cohort (mean age, 82 years; 52{\%} males), being severe in 2.7{\%}. Severe MS was associated with higher in-hospital mortality rates (5.6{\%} vs. 3.9{\%} for nonsevere MS and 4.1{\%} for no MS; p = 0.02). In contrast to those without MS, severe MS group had significantly higher risk for the primary outcome, mortality (1 year), and heart failure–related hospitalization (1 year) (adjusted hazard ratio: 1.2 [95{\%} confidence interval (CI): 1.1 to 1.4], 1.2 [95{\%} CI: 1.0 to 1.4], and 1.3 [95{\%} CI: 1.1 to 1.5], respectively; p < 0.05 for all). Conclusions: Approximately one-tenth of patients undergoing TAVR have concomitant MS. Severe MS is an independent predictor of 1-year adverse clinical outcomes following TAVR. The higher risk for long-term adverse events must be considered when evaluating patients with combined aortic stenosis and MS for TAVR.",
keywords = "combined aortic and mitral stenoses, mitral stenosis, transcatheter aortic valve replacement",
author = "Lee Joseph and Mohammad Bashir and Qun Xiang and Yerokun, {Babatunde A.} and Matsouaka, {Roland Albert} and Sreekanth Vemulapalli and Samir Kapadia and Joaquin Cigarroa and Firas Zahr",
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T1 - Prevalence and Outcomes of Mitral Stenosis in Patients Undergoing Transcatheter Aortic Valve Replacement

T2 - Findings From the Society of Thoracic Surgeons/American College of Cardiology Transcatheter Valve Therapies Registry

AU - Joseph, Lee

AU - Bashir, Mohammad

AU - Xiang, Qun

AU - Yerokun, Babatunde A.

AU - Matsouaka, Roland Albert

AU - Vemulapalli, Sreekanth

AU - Kapadia, Samir

AU - Cigarroa, Joaquin

AU - Zahr, Firas

PY - 2018/4/9

Y1 - 2018/4/9

N2 - Objectives: This study sought to examine the prevalence of mitral stenosis (MS) and its impact on in-hospital and 1-year clinical outcomes among patients undergoing transcatheter aortic valve replacement (TAVR). Background: Patients with coexisting severe aortic stenosis and MS are increasingly being considered for TAVR. Methods: The study cohort included 44,755 patients (age ≥18 years) who underwent TAVR during November 1, 2011, to September 30, 2015, and were registered in Society of Thoracic Surgeons/American College of Cardiology Transcatheter Valve Therapies (TVT) Registry. One-year outcomes were assessed by linking TVT registry data of this cohort to patient-specific Centers for Medicare & Medicaid Services administrative claims data (n = 31,453). The primary outcome was the composite of death, stroke, heart failure–related hospitalization, and mitral valve intervention at 1 year. Results: MS was present in 11.6% of cohort (mean age, 82 years; 52% males), being severe in 2.7%. Severe MS was associated with higher in-hospital mortality rates (5.6% vs. 3.9% for nonsevere MS and 4.1% for no MS; p = 0.02). In contrast to those without MS, severe MS group had significantly higher risk for the primary outcome, mortality (1 year), and heart failure–related hospitalization (1 year) (adjusted hazard ratio: 1.2 [95% confidence interval (CI): 1.1 to 1.4], 1.2 [95% CI: 1.0 to 1.4], and 1.3 [95% CI: 1.1 to 1.5], respectively; p < 0.05 for all). Conclusions: Approximately one-tenth of patients undergoing TAVR have concomitant MS. Severe MS is an independent predictor of 1-year adverse clinical outcomes following TAVR. The higher risk for long-term adverse events must be considered when evaluating patients with combined aortic stenosis and MS for TAVR.

AB - Objectives: This study sought to examine the prevalence of mitral stenosis (MS) and its impact on in-hospital and 1-year clinical outcomes among patients undergoing transcatheter aortic valve replacement (TAVR). Background: Patients with coexisting severe aortic stenosis and MS are increasingly being considered for TAVR. Methods: The study cohort included 44,755 patients (age ≥18 years) who underwent TAVR during November 1, 2011, to September 30, 2015, and were registered in Society of Thoracic Surgeons/American College of Cardiology Transcatheter Valve Therapies (TVT) Registry. One-year outcomes were assessed by linking TVT registry data of this cohort to patient-specific Centers for Medicare & Medicaid Services administrative claims data (n = 31,453). The primary outcome was the composite of death, stroke, heart failure–related hospitalization, and mitral valve intervention at 1 year. Results: MS was present in 11.6% of cohort (mean age, 82 years; 52% males), being severe in 2.7%. Severe MS was associated with higher in-hospital mortality rates (5.6% vs. 3.9% for nonsevere MS and 4.1% for no MS; p = 0.02). In contrast to those without MS, severe MS group had significantly higher risk for the primary outcome, mortality (1 year), and heart failure–related hospitalization (1 year) (adjusted hazard ratio: 1.2 [95% confidence interval (CI): 1.1 to 1.4], 1.2 [95% CI: 1.0 to 1.4], and 1.3 [95% CI: 1.1 to 1.5], respectively; p < 0.05 for all). Conclusions: Approximately one-tenth of patients undergoing TAVR have concomitant MS. Severe MS is an independent predictor of 1-year adverse clinical outcomes following TAVR. The higher risk for long-term adverse events must be considered when evaluating patients with combined aortic stenosis and MS for TAVR.

KW - combined aortic and mitral stenoses

KW - mitral stenosis

KW - transcatheter aortic valve replacement

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