Balloon-expandable versus self-expanding valves in patients with prior surgical mitral valve replacement undergoing transcatheter aortic valve replacement

Background: Pre-existing mitral prosthesis raises technical challenges for transcatheter aortic valve replacement (TAVR) but has been scarcely studied. In this work we sought to compare outcomes of patients with previous surgical mitral valve prostheses undergoing TAVR with balloon-expandable valve...

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Autores: Asmarats, Lluís, Jiménez Quevedo, Pilar, Amat Santos, Ignacio J., Ferrer Gracía, Marí Cruz, Sarnago Cebada, Fernando, Alonso Briales, Juan H., Oteo Domínguez, Juan Francisco, Serra García, Vicenç, Muntané Carol, Guillem, Vilalta, Victoria, Val, David del, Pan Álvarez Ossorio, Manuel, Torre Hernández, José María de la, García Blas, Sergio, Díez Gil, José Luís, Berenguer, Alberto, Valle Fernández, Raquel del, Navarro del Amo, Felipe, Artaiz Urdaci, Miguel, Regueiro, Ander, López Pérez, Manuel, Massó Van Roessel, Albert, Paredes Vázquez, José G., Fernández Cordón, Clara, Diarte de Miguel, José Antonio, Maneiro Melón, Nicolás, Piserra López, Alberto, Fuente, Jorge de la, Muñoz, Juan, Romaguera, Rafael, Carrillo, Xavier, Alfonso, Fernando, Alvarado, Marco, Veiga Fernández, Gabriela, Millán, Xavier, Nombela Franco, Luis, Arzamendi, Dabit
Formato: artículo
Estado:Versión publicada
Fecha de publicación:2025
País:España
Recursos:Universidad de Barcelona
Repositorio:Dipòsit Digital de la UB
OAI Identifier:oai:diposit.ub.edu:2445/223348
Acesso em linha:https://hdl.handle.net/2445/223348
Access Level:acceso abierto
Palavra-chave:Pròtesis valvulars cardíaques
Cirurgia cardiovascular
Heart valve prosthesis
Cardiovascular surgery
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spelling Balloon-expandable versus self-expanding valves in patients with prior surgical mitral valve replacement undergoing transcatheter aortic valve replacementAsmarats, LluísJiménez Quevedo, PilarAmat Santos, Ignacio J.Ferrer Gracía, Marí CruzSarnago Cebada, FernandoAlonso Briales, Juan H.Oteo Domínguez, Juan FranciscoSerra García, VicençMuntané Carol, GuillemVilalta, VictoriaVal, David delPan Álvarez Ossorio, ManuelTorre Hernández, José María de laGarcía Blas, SergioDíez Gil, José LuísBerenguer, AlbertoValle Fernández, Raquel delNavarro del Amo, FelipeArtaiz Urdaci, MiguelRegueiro, AnderLópez Pérez, ManuelMassó Van Roessel, AlbertParedes Vázquez, José G.Fernández Cordón, ClaraDiarte de Miguel, José AntonioManeiro Melón, NicolásPiserra López, AlbertoFuente, Jorge de laMuñoz, JuanRomaguera, RafaelCarrillo, XavierAlfonso, FernandoAlvarado, MarcoVeiga Fernández, GabrielaMillán, XavierNombela Franco, LuisArzamendi, DabitPròtesis valvulars cardíaquesCirurgia cardiovascularHeart valve prosthesisCardiovascular surgeryBackground: Pre-existing mitral prosthesis raises technical challenges for transcatheter aortic valve replacement (TAVR) but has been scarcely studied. In this work we sought to compare outcomes of patients with previous surgical mitral valve prostheses undergoing TAVR with balloon-expandable valve (BEV) or self-expanding valve (SEV) systems. Methods: Patients from the Spanish TAVR registry with pre-existing surgical mitral prostheses were included in this investigation. The primary endpoints were Valve Academic Research Consortium-3 technical and device success, with analysis according to valve type. Transcatheter heart valve (THV) embolization, mitral valve impingement, THV performance, and pacemaker findings were also assessed. Results: A total of 243 patients were included (37% BEVs, 63% SEVs). Overall technical success was 95.9%. Thirty-day device success was higher in BEV patients (94.4% vs 85.0%, P = 0.036), mainly driven by fewer incidences of moderate residual aortic regurgitation (0% vs 5.9%, P = 0.028) and THV embolization (0% vs 3.9%, P = 0.087). BEV recipients exhibited higher mean transvalvular gradients (10.5 vs 8.1 mm Hg, P = 0.002) and lower rates of permanent pacemaker implantation (5.6% vs 15.7%, P = 0.023). There were no differences in mortality, bleeding, or readmission at 30 days. In the multivariate analysis, a mitroaortic distance of < 7 mm and lack of trans-esophageal echocardiography guidance were associated with increased device failure. Conclusions: In patients with pre-existing MV prostheses, TAVR was safe and effective regardless of the THV type. Nevertheless, the use of BEVs resulted in an increased rate of device success, driven by lesser THV embolization and residual aortic regurgitation.Elsevier BV2025info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersionapplication/pdfhttps://hdl.handle.net/2445/223348Articles publicats en revistes (Institut d'lnvestigació Biomèdica de Bellvitge (IDIBELL))reponame:Dipòsit Digital de la UBinstname:Universidad de BarcelonaInglésReproducció del document publicat a: https://doi.org/10.1016/j.cjca.2025.04.026Canadian Journal of Cardiology, 2025, vol. 41, num. 8, p. 1480-1489https://doi.org/10.1016/j.cjca.2025.04.026cc-by (c) Asmarats, Lluís et al., 2025http://creativecommons.org/licenses/by/3.0/es/info:eu-repo/semantics/openAccessoai:diposit.ub.edu:2445/2233482026-05-27T06:46:51Z
dc.title.none.fl_str_mv Balloon-expandable versus self-expanding valves in patients with prior surgical mitral valve replacement undergoing transcatheter aortic valve replacement
title Balloon-expandable versus self-expanding valves in patients with prior surgical mitral valve replacement undergoing transcatheter aortic valve replacement
spellingShingle Balloon-expandable versus self-expanding valves in patients with prior surgical mitral valve replacement undergoing transcatheter aortic valve replacement
Asmarats, Lluís
Pròtesis valvulars cardíaques
Cirurgia cardiovascular
Heart valve prosthesis
Cardiovascular surgery
title_short Balloon-expandable versus self-expanding valves in patients with prior surgical mitral valve replacement undergoing transcatheter aortic valve replacement
title_full Balloon-expandable versus self-expanding valves in patients with prior surgical mitral valve replacement undergoing transcatheter aortic valve replacement
title_fullStr Balloon-expandable versus self-expanding valves in patients with prior surgical mitral valve replacement undergoing transcatheter aortic valve replacement
title_full_unstemmed Balloon-expandable versus self-expanding valves in patients with prior surgical mitral valve replacement undergoing transcatheter aortic valve replacement
title_sort Balloon-expandable versus self-expanding valves in patients with prior surgical mitral valve replacement undergoing transcatheter aortic valve replacement
dc.creator.none.fl_str_mv Asmarats, Lluís
Jiménez Quevedo, Pilar
Amat Santos, Ignacio J.
Ferrer Gracía, Marí Cruz
Sarnago Cebada, Fernando
Alonso Briales, Juan H.
Oteo Domínguez, Juan Francisco
Serra García, Vicenç
Muntané Carol, Guillem
Vilalta, Victoria
Val, David del
Pan Álvarez Ossorio, Manuel
Torre Hernández, José María de la
García Blas, Sergio
Díez Gil, José Luís
Berenguer, Alberto
Valle Fernández, Raquel del
Navarro del Amo, Felipe
Artaiz Urdaci, Miguel
Regueiro, Ander
López Pérez, Manuel
Massó Van Roessel, Albert
Paredes Vázquez, José G.
Fernández Cordón, Clara
Diarte de Miguel, José Antonio
Maneiro Melón, Nicolás
Piserra López, Alberto
Fuente, Jorge de la
Muñoz, Juan
Romaguera, Rafael
Carrillo, Xavier
Alfonso, Fernando
Alvarado, Marco
Veiga Fernández, Gabriela
Millán, Xavier
Nombela Franco, Luis
Arzamendi, Dabit
author Asmarats, Lluís
author_facet Asmarats, Lluís
Jiménez Quevedo, Pilar
Amat Santos, Ignacio J.
Ferrer Gracía, Marí Cruz
Sarnago Cebada, Fernando
Alonso Briales, Juan H.
Oteo Domínguez, Juan Francisco
Serra García, Vicenç
Muntané Carol, Guillem
Vilalta, Victoria
Val, David del
Pan Álvarez Ossorio, Manuel
Torre Hernández, José María de la
García Blas, Sergio
Díez Gil, José Luís
Berenguer, Alberto
Valle Fernández, Raquel del
Navarro del Amo, Felipe
Artaiz Urdaci, Miguel
Regueiro, Ander
López Pérez, Manuel
Massó Van Roessel, Albert
Paredes Vázquez, José G.
Fernández Cordón, Clara
Diarte de Miguel, José Antonio
Maneiro Melón, Nicolás
Piserra López, Alberto
Fuente, Jorge de la
Muñoz, Juan
Romaguera, Rafael
Carrillo, Xavier
Alfonso, Fernando
Alvarado, Marco
Veiga Fernández, Gabriela
Millán, Xavier
Nombela Franco, Luis
Arzamendi, Dabit
author_role author
author2 Jiménez Quevedo, Pilar
Amat Santos, Ignacio J.
Ferrer Gracía, Marí Cruz
Sarnago Cebada, Fernando
Alonso Briales, Juan H.
Oteo Domínguez, Juan Francisco
Serra García, Vicenç
Muntané Carol, Guillem
Vilalta, Victoria
Val, David del
Pan Álvarez Ossorio, Manuel
Torre Hernández, José María de la
García Blas, Sergio
Díez Gil, José Luís
Berenguer, Alberto
Valle Fernández, Raquel del
Navarro del Amo, Felipe
Artaiz Urdaci, Miguel
Regueiro, Ander
López Pérez, Manuel
Massó Van Roessel, Albert
Paredes Vázquez, José G.
Fernández Cordón, Clara
Diarte de Miguel, José Antonio
Maneiro Melón, Nicolás
Piserra López, Alberto
Fuente, Jorge de la
Muñoz, Juan
Romaguera, Rafael
Carrillo, Xavier
Alfonso, Fernando
Alvarado, Marco
Veiga Fernández, Gabriela
Millán, Xavier
Nombela Franco, Luis
Arzamendi, Dabit
author2_role author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
dc.subject.none.fl_str_mv Pròtesis valvulars cardíaques
Cirurgia cardiovascular
Heart valve prosthesis
Cardiovascular surgery
topic Pròtesis valvulars cardíaques
Cirurgia cardiovascular
Heart valve prosthesis
Cardiovascular surgery
description Background: Pre-existing mitral prosthesis raises technical challenges for transcatheter aortic valve replacement (TAVR) but has been scarcely studied. In this work we sought to compare outcomes of patients with previous surgical mitral valve prostheses undergoing TAVR with balloon-expandable valve (BEV) or self-expanding valve (SEV) systems. Methods: Patients from the Spanish TAVR registry with pre-existing surgical mitral prostheses were included in this investigation. The primary endpoints were Valve Academic Research Consortium-3 technical and device success, with analysis according to valve type. Transcatheter heart valve (THV) embolization, mitral valve impingement, THV performance, and pacemaker findings were also assessed. Results: A total of 243 patients were included (37% BEVs, 63% SEVs). Overall technical success was 95.9%. Thirty-day device success was higher in BEV patients (94.4% vs 85.0%, P = 0.036), mainly driven by fewer incidences of moderate residual aortic regurgitation (0% vs 5.9%, P = 0.028) and THV embolization (0% vs 3.9%, P = 0.087). BEV recipients exhibited higher mean transvalvular gradients (10.5 vs 8.1 mm Hg, P = 0.002) and lower rates of permanent pacemaker implantation (5.6% vs 15.7%, P = 0.023). There were no differences in mortality, bleeding, or readmission at 30 days. In the multivariate analysis, a mitroaortic distance of < 7 mm and lack of trans-esophageal echocardiography guidance were associated with increased device failure. Conclusions: In patients with pre-existing MV prostheses, TAVR was safe and effective regardless of the THV type. Nevertheless, the use of BEVs resulted in an increased rate of device success, driven by lesser THV embolization and residual aortic regurgitation.
publishDate 2025
dc.date.none.fl_str_mv 2025
dc.type.none.fl_str_mv info:eu-repo/semantics/article
info:eu-repo/semantics/publishedVersion
format article
status_str publishedVersion
dc.identifier.none.fl_str_mv https://hdl.handle.net/2445/223348
url https://hdl.handle.net/2445/223348
dc.language.none.fl_str_mv Inglés
language_invalid_str_mv Inglés
dc.relation.none.fl_str_mv Reproducció del document publicat a: https://doi.org/10.1016/j.cjca.2025.04.026
Canadian Journal of Cardiology, 2025, vol. 41, num. 8, p. 1480-1489
https://doi.org/10.1016/j.cjca.2025.04.026
dc.rights.none.fl_str_mv cc-by (c) Asmarats, Lluís et al., 2025
http://creativecommons.org/licenses/by/3.0/es/
info:eu-repo/semantics/openAccess
rights_invalid_str_mv cc-by (c) Asmarats, Lluís et al., 2025
http://creativecommons.org/licenses/by/3.0/es/
eu_rights_str_mv openAccess
dc.format.none.fl_str_mv application/pdf
dc.publisher.none.fl_str_mv Elsevier BV
publisher.none.fl_str_mv Elsevier BV
dc.source.none.fl_str_mv Articles publicats en revistes (Institut d'lnvestigació Biomèdica de Bellvitge (IDIBELL))
reponame:Dipòsit Digital de la UB
instname:Universidad de Barcelona
instname_str Universidad de Barcelona
reponame_str Dipòsit Digital de la UB
collection Dipòsit Digital de la UB
repository.name.fl_str_mv
repository.mail.fl_str_mv
_version_ 1869403449579274240
score 15.223283

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