title: Bivalvular transcatheter treatment of high-surgical-risk patients with coexisting severe aortic stenosis and significant mitral regurgitation.
abstract: BACKGROUND
  In inoperable or high-surgical-risk patients, transcatheter aortic valve replacement (TAVR) and repair of the mitral valve using the MitraClip have emerged as novel treatment strategies. We sought to assess the feasibility and effectiveness of bivalvular transcatheter therapy in patients with coexisting aortic stenosis and mitral regurgitation.
  
  
  METHODS
  Out of 285 patients treated with TAVR and 226 patients who underwent MitraClip therapy at our institution, 11 patients (78 ± 6years, 9 men [82%]) received both therapies. TAVR preceded MitraClip therapy in 10 patients, with 3 patients undergoing both interventions in a single session.
  
  
  RESULTS
  TAVR via transapical (n = 6) or transfemoral (n = 5) access utilized the Sapien/Sapien XT and CoreValve prostheses in 7 and 4 patients, respectively. All TAVR procedures were successful, with significant increases in effective aortic orifice area and decreases in mean transvalvular pressure gradient. MitraClip therapy succeeded in reducing MR severity to <2+ in 10 patients. Periprocedurally, 1 patient sustained a stroke. At a median of 208 days, 2 patients were in NYHA functional class II, with only 1 patient improved from before TAVR, and 6 patients were in class III (improvement in 1). Four patients had died at a median of 60 days after MitraClip therapy.
  
  
  CONCLUSIONS
  Bivalvular transcatheter treatment of patients with coexisting aortic stenosis and MR is technically feasible, even in a single session. Given the low prevalence of midterm functional improvement, factors predictive of clinical benefit from catheter-based double-valve intervention remain to be determined.
authors.affiliation: Department of General and Interventional Cardiology, University Heart Center, Hamburg, Germany.
authors.forename: Volker
authors.initials: V
authors.lastname: Rudolph
authors.forename: Johannes
authors.initials: J
authors.lastname: Schirmer
authors.forename: Olaf
authors.initials: O
authors.lastname: Franzen
authors.forename: Michael
authors.initials: M
authors.lastname: Schlüter
authors.forename: Moritz
authors.initials: M
authors.lastname: Seiffert
authors.forename: Hendrik
authors.initials: H
authors.lastname: Treede
authors.forename: Hermann
authors.initials: H
authors.lastname: Reichenspurner
authors.forename: Stefan
authors.initials: S
authors.lastname: Blankenberg
authors.forename: Stephan
authors.initials: S
authors.lastname: Baldus
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy*; D006328:Cardiac Catheterization / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D019918:Heart Valve Prosthesis Implantation / Q000379:methods*; D006801:Humans; D008297:Male; D008944:Mitral Valve Insufficiency / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy*; D012307:Risk Factors; D012720:Severity of Illness Index; D013525:Surgical Instruments; D016896:Treatment Outcome