Thorac Cardiovasc Surg
DOI: 10.1055/s-0039-1700966
Original Cardiovascular
Georg Thieme Verlag KG Stuttgart · New York

TAVI in Patients with Mitral Annular Calcification and/or Mitral Stenosis

Andreas Schaefer
1  Department of Cardiovascular Surgery, University Heart Center Hamburg, Hamburg, Germany
,
Harun Sarwari
1  Department of Cardiovascular Surgery, University Heart Center Hamburg, Hamburg, Germany
,
Niklas Schofer
2  Department of General and Interventional Cardiology, University Heart Center Hamburg, Hamburg, Germany
,
Yvonne Schneeberger
1  Department of Cardiovascular Surgery, University Heart Center Hamburg, Hamburg, Germany
,
Dirk Westermann
2  Department of General and Interventional Cardiology, University Heart Center Hamburg, Hamburg, Germany
,
Gerhard Schoen
3  Department of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf
,
Stefan Blankenberg
2  Department of General and Interventional Cardiology, University Heart Center Hamburg, Hamburg, Germany
,
Hermann Reichenspurner
1  Department of Cardiovascular Surgery, University Heart Center Hamburg, Hamburg, Germany
,
Ulrich Schäfer
2  Department of General and Interventional Cardiology, University Heart Center Hamburg, Hamburg, Germany
,
Lenard Conradi
1  Department of Cardiovascular Surgery, University Heart Center Hamburg, Hamburg, Germany
› Author Affiliations
Funding Statement No funding was received regarding this work.
Further Information

Publication History

10 August 2019

19 November 2019

Publication Date:
01 March 2020 (online)

Abstract

Background We herein aimed for analysis of influence of mitral annular calcification (MAC) and mitral stenosis (MS) on outcomes in transcatheter aortic valve implantation (TAVI).

Methods Between 11/2009 and 06/2017, 1,058 patients underwent TAVI in the presence of concomitant MAC or MS at our center. Subgroups were built and multivariate logistic regression, COX regression, Kaplan–Meier survival analyses, and receiver operating characteristics method were performed.

Results Thirty-day mortality was 7.5% (79/1,058) with highest mortality in patients severe MS (MAC: 3.4% vs. mild MS: 5.9% vs. moderate MS: 15.0% vs. severe MS: 72.7%; p < 0.001). Moderate-to-severe MS (odds ratio [OR]: 7.75, confidence interval [CI]: 3.94–16.26, p < 0.001), impaired left ventricular ejection fraction (OR: 1.38, CI: 1.10–1.72, p < 0.01), and coronary artery disease (OR: 1.36, CI: 1.11–1.67, p < 0.01) were predictive of 30-day survival. Left ventricular systolic/end-diastolic pressure drop of <59.5 mm Hg / <19.5 mm Hg was associated with increased mortality.

Conclusions TAVI in the presence of MAC and mild MS is associated with acceptable acute outcomes but should be considered high-risk procedures in patients with moderate and especially those with severe MS. Our results suggest adverse hemodynamics after TAVI with concomitant MS, which may be caused by underfilling of the left ventricle leading to low-cardiac output.

Author Contributions

Andreas Schaefer made substantial contributions to the conception and design of the work; to the acquisition, analysis, and interpretation of data for the work; to drafting the work and revising it critically for important intellectual content; to final approval of the version to be published; and agrees to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.


Harun Sarwari made substantial contributions to the conception and design of the work; to the acquisition of data for the work; to drafting the work; to final approval of the version to be published; and agrees to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.


Niklas Schofer made substantial contributions to the conception and design of the work; to drafting the work and revising it critically for important intellectual content; to final approval of the version to be published; and agrees to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.


Yvonne Schneeberger made substantial contributions to the conception and design of the work; to drafting the work and revising it critically for important intellectual content; to final approval of the version to be published; and agrees to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.


Dirk Westermann made substantial contributions to the conception and design of the work; to drafting the work and revising it critically for important intellectual content; to final approval of the version to be published; and agrees to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.


Gerhard Schoen made substantial contributions to the conception and design of the work; to the acquisition, analysis, and interpretation of data for the work, to drafting the work and revising it critically for important intellectual content; to final approval of the version to be published; and agrees to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.


Stefan Blankenberg made substantial contributions to the conception and design of the work; to drafting the work and revising it critically for important intellectual content; to final approval of the version to be published; and agrees to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.


Hermann Reichenspurner made substantial contributions to the conception and design of the work; to drafting the work and revising it critically for important intellectual content; to final approval of the version to be published; and agrees to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.


Ulrich Schäfer made substantial contributions to the conception and design of the work; to drafting the work and revising it critically for important intellectual content; to final approval of the version to be published; and agrees to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.


Lenard Conradi made substantial contributions to the conception and design of the work; to the acquisition, analysis, and interpretation of data for the work; to drafting the work and revising it critically for important intellectual content; to final approval of the version to be published; and agrees to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.


Disclosure Statement

A. Schaefer has received travel compensation from Symetis SA and Abbott Vascular Inc.


U. Schaefer is a proctor for Symetis SA and Medtronic, is a consultant to Medtronic and Symetis SA, and has received lecture fees from Medtronic.


L. Conradi is a proctor for Boston Scientific and Medtronic and proctor and consultant for Edwards Lifesciences.


All others authors have nothing to disclose.


Supplementary Material