title: Combined mitro-aortic pathology: impact of previous aortic valve replacement upon outcomes of MitraClip therapy (from the German transcatheter mitral valve interventions registry).
abstract: OBJECTIVE
  The aim of this study was to identify the impact of previous aortic valve replacement (AVR) in MitraClip (MC) patients.
  
  
  RESULTS
  Data from the German transcatheter mitral valve interventions (TRAMI) registry were analysed in the light of previous AVR by means of either standard AVR (SAVR) or transcatheter AVR (TAVR). Out of 791 MC patients, 68 (8.6%) had been submitted to AVR (68.4% SAVR and 31.6% TAVR). The AVR group was significantly older (77.2±8.0 years vs. 75.1±8.6 years; p<0.05) and had a trend towards a higher risk profile (median STS score 10 [8.0-12.0] vs. 6.0 [3.0-11.0]; p=0.1). No procedural mortality was observed. Severe residual MV regurgitation was reported in 6.2% of AVR vs. 3.7% of the no-AVR patients (p=0.1). Thirty-day mortality was 10.6% in the previous AVR group vs. 3.9% in the no-AVR group (p<0.05). One-year estimated survival was lower in the AVR group (AVR 63% vs. no-AVR 81%; p<0.0001; HR 2.25, 95% CI: 1.42-3.55). Estimated survival in TAVR compared to SAVR was lower (TAVR 44.4% vs. SAVR 70%; p=0.039; HR 2.32, 95% CI: 0.99-5.37). AVR was a determinant of follow-up mortality (HR 2.18, 95% CI: 1.4-3.4; p<0.001).
  
  
  CONCLUSIONS
  Previous AVR in patients undergoing MC therapy carries a heavy and independent burden of mortality/morbidity.
authors.affiliation: Vivantes Klinikum im Friedrichshain und Am Urban, Berlin, Germany and Rostock University Medical Center, Rostock, Germany.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: D'Ancona
authors.forename: Stephan
authors.initials: S
authors.lastname: Kische
authors.forename: Jochen
authors.initials: J
authors.lastname: Senges
authors.forename: Taoufik
authors.initials: T
authors.lastname: Ouarrak
authors.forename: Miriam
authors.initials: M
authors.lastname: Puls
authors.forename: Raffi
authors.initials: R
authors.lastname: Bekeredjian
authors.forename: Horst
authors.initials: H
authors.lastname: Sievert
authors.forename: Erdal
authors.initials: E
authors.lastname: Safak
authors.forename: Jasmin
authors.initials: J
authors.lastname: Ortak
authors.forename: Alper
authors.initials: A
authors.lastname: Öner
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Schillinger
authors.forename: Hüseyin
authors.initials: H
authors.lastname: Ince
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000601:surgery*; D001024:Aortic Valve Stenosis / Q000601:surgery*; D006328:Cardiac Catheterization / Q000379:methods; D005260:Female; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000379:methods; D006801:Humans; D008297:Male; D008943:Mitral Valve / Q000601:surgery*; D012042:Registries; D012307:Risk Factors; D065467:Transcatheter Aortic Valve Replacement / Q000379:methods; D016896:Treatment Outcome