Clinical effect of transcatheter aortic valve replacement on severe aortic regurgitation combined with severe mitral regurgitation: A single-center retrospective study_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

WU Hongxiang ¹ , TAN Tong ^1,2 , WEI Peijian ^1,2 , LIU Yanjun ¹ , LI Xiaoyi ¹ , ZHU Wei ¹ , HUANG Huanlei ¹ ,  LIU Jian ¹ ,  GUO Huiming ¹ , CHEN Jimei ¹ , ZHUANG Jian ¹

1. Department of Cardiovascular Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, P. R. China;
2. Shantou University Medical College, Shantou, 515041, Guangdong, P. R. China;

Corresponding author：

LIU Jian, Email: jianliu_gdpph@sina.com; GUO Huiming, Email: guohuiming@gdph.org.cn

Keywords：

Transcatheter aortic valve replacement; severe mitral regurgitation; functional mitral regurgitation; severe aortic regurgitation

DOI：

10.7507/1007-4848.202202013

Video：

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Objective To determine the clinical efficacy of transcatheter aortic valve replacement (TAVR) for severe aortic regurgitation (AR) combined with severe mitral regurgitation (MR). Methods The clinical data of 13 patients who underwent TAVR due to severe AR combined with severe MR from March 2018 to September 2021 in our hospital were retrospectively analyzed, including 10 males and 3 females with a mean age of 72.54±2.35 years. The echocardiographic findings of all patients were compared preoperatively and postoperatively. Results Surgeries were performed successfully in all patients without intraoperative death or conversion to sternotomy. The operation time was 118.15±11.42 min, intraoperative blood loss was 100.00 (75.00, 250.00) mL, and the length of hospital stay after surgery was 9.00 (4.50, 11.00) d. The mean follow-up duration was 10.00 (6.50, 38.50) months, during which there were 2 patients with mild to moderate AR, 6 with mild AR, and 5 with no AR; meanwhile, severe MR decreased significantly (P=0.001) even without active intervention, including 4 mild to moderate MR and 9 mild MR patients. Compared to preoperative indexes, the left atrial diameter [46.00 (41.00, 52.50) mm vs. 35.00 (34.00, 41.00) mm, P<0.001], left ventricular end-systolic diameter [45.00 (36.00, 56.00) mm vs. 35.00 (28.00, 39.00) mm, P=0.002] and left ventricular end-diastolic diameter (62.62±2.40 mm vs. 51.08±2.49 mm, P<0.001) showed a decreasing trend during the follow-up. Conclusion In selected patients with severe AR combined with severe MR, TAVR alone improves AR and combined MR at the same time.

Citation： WU Hongxiang, TAN Tong, WEI Peijian, LIU Yanjun, LI Xiaoyi, ZHU Wei, HUANG Huanlei, LIU Jian, GUO Huiming, CHEN Jimei, ZHUANG Jian. Clinical effect of transcatheter aortic valve replacement on severe aortic regurgitation combined with severe mitral regurgitation: A single-center retrospective study. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2022, 29(8): 971-976. doi: 10.7507/1007-4848.202202013 Copy

1.	Cribier A, Eltchaninoff H, Bash A, et al. Percutaneous transcatheter implantation of an aortic valve prosthesis for calcific aortic stenosis: First human case description. Circulation, 2002, 106(24): 3006-3008.
2.	Zhu D, Hu J, Meng W, et al. Successful transcatheter aortic valve implantation for pure aortic regurgitation using a new second generation self-expanding J-Valve(TM) system—The first in-man implantation. Heart Lung Circ, 2015, 24(4): 411-414.
3.	Wei L, Liu H, Zhu L, et al. A new transcatheter aortic valve replacement system for predominant aortic regurgitation implantation of the J-Valve and early outcome. JACC Cardiovasc Interv, 2015, 8(14): 1831-1841.
4.	Iung B, Baron G, Butchart EG, et al. A prospective survey of patients with valvular heart disease in Europe: The Euro heart survey on valvular heart disease. Eur Heart J, 2003, 24(13): 1231-1243.
5.	Miura M, Yamaji K, Shirai S, et al. Clinical impact of preprocedural moderate or severe mitral regurgitation on outcomes after transcatheter aortic valve replacement. Can J Cardiol, 2020, 36(7): 1112-1120.
6.	Lee R, Li S, Rankin JS, et al. Fifteen-year outcome trends for valve surgery in North America. Ann Thorac Surg, 2011, 91(3): 677-684.
7.	Beaudoin J, Handschumacher MD, Zeng X, et al. Mitral valve enlargement in chronic aortic regurgitation as a compensatory mechanism to prevent functional mitral regurgitation in the dilated left ventricle. J Am Coll Cardiol, 2013, 61(17): 1809-1816.
8.	Pai RG, Varadarajan P. Prognostic implications of mitral regurgitation in patients with severe aortic regurgitation. Circulation, 2010, 122(11 Suppl): S43-S47.
9.	Duchenne J, Turco A, Bézy S, et al. Papillary muscles contribute significantly more to left ventricular work in dilated hearts. Eur Heart J Cardiovasc Imaging, 2019, 20(1): 84-91.
10.	Breithardt OA, Sinha AM, Schwammenthal E, et al. Acute effects of cardiac resynchronization therapy on functional mitral regurgitation in advanced systolic heart failure. J Am Coll Cardiol, 2003, 41(5): 765-770.
11.	Unger P, Pibarot P, Tribouilloy C, et al. Multiple and mixed valvular heart diseases. Circ Cardiovasc Imaging, 2018, 11(8): e007862.
12.	Gentles TL, Finucane AK, Remenyi B, et al. Ventricular function before and after surgery for isolated and combined regurgitation in the young. Ann Thorac Surg, 2015, 100(4): 1383-1389.
13.	Skudicky D, Essop MR, Sareli P. Time-related changes in left ventricular function after double valve replacement for combined aortic and mitral regurgitation in a young rheumatic population. Predictors of postoperative left ventricular performance and role of chordal preservation. Circulation, 1997, 95(4): 899-904.
14.	赵振刚, 陈飞, 陈茂. 心脏瓣膜病的介入治疗进展. 华西医学, 2020, 35(4): 401-405.
15.	Vahanian A, Beyersdorf F, Praz F, et al. 2021 ESC/EACTS guidelines for the management of valvular heart disease. EuroIntervention, 2022, 17(14): e1126-e1196.
16.	Otto CM, Nishimura RA, Bonow RO, et al. 2020 ACC/AHA guideline for the management of patients with valvular heart disease: A report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. J Thorac Cardiovasc Surg, 2021, 162(2): e183-e353.
17.	Wan CK, Suri RM, Li Z, et al. Management of moderate functional mitral regurgitation at the time of aortic valve replacement: Is concomitant mitral valve repair necessary? J Thorac Cardiovasc Surg, 2009, 137(3): 635-640.
18.	Lim JY, Jung SH, Kim JB, et al. Management of concomitant mild to moderate functional mitral regurgitation during aortic valve surgery for severe aortic insufficiency. J Thorac Cardiovasc Surg, 2014, 148(2): 441-446.
19.	Xu Y, Zhao L, Zhang L, et al. Left atrial enlargement and the risk of stroke: A meta-analysis of prospective cohort studies. Front Neurol, 2020, 11: 26.
20.	Seko Y, Kato T, Haruna T, et al. Association between atrial fibrillation, atrial enlargement, and left ventricular geometric remodeling. Sci Rep, 2018, 8(1): 6366.

1. Cribier A, Eltchaninoff H, Bash A, et al. Percutaneous transcatheter implantation of an aortic valve prosthesis for calcific aortic stenosis: First human case description. Circulation, 2002, 106(24): 3006-3008.
2. Zhu D, Hu J, Meng W, et al. Successful transcatheter aortic valve implantation for pure aortic regurgitation using a new second generation self-expanding J-Valve(TM) system—The first in-man implantation. Heart Lung Circ, 2015, 24(4): 411-414.
3. Wei L, Liu H, Zhu L, et al. A new transcatheter aortic valve replacement system for predominant aortic regurgitation implantation of the J-Valve and early outcome. JACC Cardiovasc Interv, 2015, 8(14): 1831-1841.
4. Iung B, Baron G, Butchart EG, et al. A prospective survey of patients with valvular heart disease in Europe: The Euro heart survey on valvular heart disease. Eur Heart J, 2003, 24(13): 1231-1243.
5. Miura M, Yamaji K, Shirai S, et al. Clinical impact of preprocedural moderate or severe mitral regurgitation on outcomes after transcatheter aortic valve replacement. Can J Cardiol, 2020, 36(7): 1112-1120.
6. Lee R, Li S, Rankin JS, et al. Fifteen-year outcome trends for valve surgery in North America. Ann Thorac Surg, 2011, 91(3): 677-684.
7. Beaudoin J, Handschumacher MD, Zeng X, et al. Mitral valve enlargement in chronic aortic regurgitation as a compensatory mechanism to prevent functional mitral regurgitation in the dilated left ventricle. J Am Coll Cardiol, 2013, 61(17): 1809-1816.
8. Pai RG, Varadarajan P. Prognostic implications of mitral regurgitation in patients with severe aortic regurgitation. Circulation, 2010, 122(11 Suppl): S43-S47.
9. Duchenne J, Turco A, Bézy S, et al. Papillary muscles contribute significantly more to left ventricular work in dilated hearts. Eur Heart J Cardiovasc Imaging, 2019, 20(1): 84-91.
10. Breithardt OA, Sinha AM, Schwammenthal E, et al. Acute effects of cardiac resynchronization therapy on functional mitral regurgitation in advanced systolic heart failure. J Am Coll Cardiol, 2003, 41(5): 765-770.
11. Unger P, Pibarot P, Tribouilloy C, et al. Multiple and mixed valvular heart diseases. Circ Cardiovasc Imaging, 2018, 11(8): e007862.
12. Gentles TL, Finucane AK, Remenyi B, et al. Ventricular function before and after surgery for isolated and combined regurgitation in the young. Ann Thorac Surg, 2015, 100(4): 1383-1389.
13. Skudicky D, Essop MR, Sareli P. Time-related changes in left ventricular function after double valve replacement for combined aortic and mitral regurgitation in a young rheumatic population. Predictors of postoperative left ventricular performance and role of chordal preservation. Circulation, 1997, 95(4): 899-904.
14. 赵振刚, 陈飞, 陈茂. 心脏瓣膜病的介入治疗进展. 华西医学, 2020, 35(4): 401-405.
15. Vahanian A, Beyersdorf F, Praz F, et al. 2021 ESC/EACTS guidelines for the management of valvular heart disease. EuroIntervention, 2022, 17(14): e1126-e1196.
16. Otto CM, Nishimura RA, Bonow RO, et al. 2020 ACC/AHA guideline for the management of patients with valvular heart disease: A report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. J Thorac Cardiovasc Surg, 2021, 162(2): e183-e353.
17. Wan CK, Suri RM, Li Z, et al. Management of moderate functional mitral regurgitation at the time of aortic valve replacement: Is concomitant mitral valve repair necessary? J Thorac Cardiovasc Surg, 2009, 137(3): 635-640.
18. Lim JY, Jung SH, Kim JB, et al. Management of concomitant mild to moderate functional mitral regurgitation during aortic valve surgery for severe aortic insufficiency. J Thorac Cardiovasc Surg, 2014, 148(2): 441-446.
19. Xu Y, Zhao L, Zhang L, et al. Left atrial enlargement and the risk of stroke: A meta-analysis of prospective cohort studies. Front Neurol, 2020, 11: 26.
20. Seko Y, Kato T, Haruna T, et al. Association between atrial fibrillation, atrial enlargement, and left ventricular geometric remodeling. Sci Rep, 2018, 8(1): 6366.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Clinical effect of transcatheter aortic valve replacement on severe aortic regurgitation combined with severe mitral regurgitation: A single-center retrospective study

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