Daniel O'Hair

Transcatheter Aortic Valve Replacement in Patients With Severe Mitral or Tricuspid Regurgitation at Extreme Risk for Surgery

Objectives: Patients with symptomatic severe aortic stenosis and severe mitral regurgitation or severe tricuspid regurgitation were excluded from the major transcatheter aortic valve replacement trials. We studied these 2 subgroups in patients at extreme risk for surgery in the prospective, nonrandomized, single‐arm CoreValve US Expanded Use Study. Methods: The primary end point was all‐cause mortality or major stroke at 1 year. A favorable medical benefit was defined as a Kansas City Cardiomyopathy Questionnaire overall summary score greater than 45 at 6 months and greater than 60 at 1 year and with a less than 10‐point decrease from baseline. Results: There were 53 patients in each group. Baseline characteristics for the severe mitral regurgitation and severe tricuspid regurgitation cohorts were age 84.2 ± 6.4 years and 84.9 ± 6.5 years; male, 29 (54.7%) and 22 (41.5%), and mean Society of Thoracic Surgeons score 9.9% ± 5.0% and 9.2% ± 4.0%, respectively. Improvement in valve regurgitation from baseline to 1 year occurred in 72.7% of the patients with severe mitral regurgitation and in 61.8% of patients with severe tricuspid regurgitation. A favorable medical benefit occurred in 31 of 47 patients (66.0%) with severe mitral regurgitation and 33 of 47 patients (70.2%) with severe tricuspid regurgitation at 6 months, and in 25 of 44 patients (56.8%) with severe mitral regurgitation and 24 of 45 patients (53.3%) with severe tricuspid regurgitation at 1 year. All‐cause mortality or major stroke for the severe mitral regurgitation and severe tricuspid regurgitation cohorts were 11.3% and 3.8% at 30 days and 21.0% and 19.2% at 1 year, respectively. There were no major strokes in either group at 1 year. Conclusions: Transcatheter aortic valve replacement in patients with severe mitral regurgitation or severe tricuspid regurgitation is reasonable and safe and leads to improvement in atrioventricular valve regurgitation.

Clinical impact of baseline chronic kidney disease in patients undergoing transcatheter or surgical aortic valve replacement

To assess the treatment effect of TAVR versus SAVR on clinical outcomes to 3 years in patients stratified by chronic kidney disease (CKD) by retrospectively studying patients randomized to TAVR or SAVR.

TCT-224 Gastrointestinal Bleed Pre-Transcatheter Aortic Valve Replacement: An Independent Predictor of Mortality

Severe aortic stenosis causes recurrent mucosal bleeds, mainly from angiodysplasias and acquired von Willebrand deficiency (vWD) which is corrected after aortic valve replacement, either transcatheter (TAVR) or surgical (SAVR). Studies have shown major GI bleeding post-TAVR as an independent

TCT- 717 Transcatheter aortic valve replacement reduces major recurrent gastrointestinal bleed in severe aortic stenosis

Severe aortic stenosis is associated with acquired Von Willebrand deficiency (vWD) manifesting with recurrent gastrointestinal bleed (GIB) if left untreated. Few small studies have shown decreased incidence of GIB after surgical aortic valve replacement (SAVR) but limited data are available with

Three-dimensional echocardiography guidance in case of papillary fibroelastoma complicating transaortic valve implantation.

A 77-year-old man with severe aortic stenosis presented for transcatheter aortic valve replacement (TAVR). His clinical history was significant for severe chronic obstructive lung disease (COPD) and prior treatment of lung cancer with surgery and chest radiation. Given his co-morbidities and frailty, he was classified as prohibitive risk for surgical aortic valve replacement. Given the anaesthesia …

What went wrong and how it got right: heart team provides value in transcatheter aortic valve replacement.

An 89-year-old woman deemed at extreme surgical risk underwent aortic CoreValve® (Medtronic Inc., Minneapolis, MN, USA) implantation. Her history was significant for hypertension and chronic lung disease. Work-up at admission revealed: blood pressure 96/43 mmHg, heart rate 80 bpm, soft second heart sound, and late-peaking systolic murmur (grade 3/6) in the precordium …

Case of the mysterious signal

A 76-year-old man underwent direct aortic CoreValve® (Medtronic Inc., Minneapolis, MN, USA). After successful implantation of the CoreValve, a transoesophageal echocardiogram showed mean and peak gradients of 5 and 14 mmHg, respectively, along with mild valvular and paravalvular aortic regurgitation. Prior to discharge from the hospital, a transthoracic echocardiogram …

Organized Granulation Tissue Mimicking Left Atrial Myxoma Recurrence

A 64-year-old woman presented to clinic with 2 months of episodic chest tightness at rest, which would last several minutes before spontaneous resolution. Her pertinent medical history included tobacco abuse, hypertension, and hypothyroidism. In addition, she had resection of a left atrial myxoma in the year 2000, after she presented with similar chest discomfort. That procedure involved resection and a patch repair of a wide-based myxoma with negative margins from the interatrial septum. Her cardiac catheterization before resection had revealed minimal coronary artery disease. Computed tomographic angiography revealed no significant epicardial coronary artery disease, but noted a pedunculated mass attached to the interatrial septum (Figure 1). Transesophageal echocardiography revealed that this was an isolated, highly mobile mass arising from the atrial septum with a long stalk and a head characteristic of myxoma (Figure 2, Movie I in the online-only Data Supplement, and Figure 3A, Movie II in the online-only …