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Current Cardiology Reports

, 21:129 | Cite as

Is There Currently a Place for Combined Mitral and Aortic Transcatheter Interventions?

  • Rodney De PalmaEmail author
  • Crochan J. O’Sullivan
  • Magnus Settergren
Structural Heart Disease (RJ Siegel and NC Wunderlich, Section Editors)
Part of the following topical collections:
  1. Topical Collection on Structural Heart Disease

Abstract

Purpose of Review

The goal was to evaluate published data on the incidence, diagnosis, and management of symptomatic combined mitral and aortic valvular disease. Furthermore, to identify the role of treatment using contemporary transcatheter techniques.

Recent Findings

Up to a quarter of symptomatic adult valvular disease is caused by multiple left-sided valvular lesions. The etiologic spectrum of this combined disease has shifted from rheumatic to degenerative. Both presentation and diagnosis of lesions are modified compared with isolated disease. Based upon narrative review, there are only limited observational experiences, insufficient to provide robust guidance. These data, however, indicate the feasibility of interventions such as transcatheter aortic valve replacement and edge-to-edge mitral valve repair to treat such disease and mitigate the risks of open surgery.

Summary

Combined aortic and mitral valve disease is commonly encountered. There is a role for transcatheter interventions based on limited data; however, more research is needed.

Keywords

Multivalve Multiple valve disease Combined valve disease Transcatheter intervention 

Notes

Compliance with Ethical Standards

Conflict of Interest

Rodney De Palma, Crochan J. O’Sullivan, and Magnus Settergren declare that they have no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. 1.
    Nkomo VT, Gardin JM, Skelton TN, Gottdiener JS, Scott CG, Enriquez-Sarano M. Burden of valvular heart diseases: a population-based study. Lancet. 2006;368:1005–11.CrossRefGoogle Scholar
  2. 2.
    Iung B, Baron G, Butchart EG, Delahaye F, Gohlke-Bärwolf C, Levang OW, 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;24:1231–43.CrossRefGoogle Scholar
  3. 3.
    Goldbarg SH, Elmariah S, Miller MA, Fuster V. Insights into degenerative aortic valve disease. J Am Coll Cardiol. 2007;50:1205–13.CrossRefGoogle Scholar
  4. 4.
    • Valvular Heart Disease II (VHDII) Survey (European Society of Cardiology website). 2018. Available at: https://esc365.escardio.org/Congress/ESC-Congress-2018/Late-Breaking-Registry-Results-1/181465-eorp-vhd-ii-registry-contemporary-mangement-of-heart-valve-disease (accessed 28th September 2018). Cross-sectional survey of valvular disease in Europe.
  5. 5.
    Kim DH, Handschumacher MD, Levine RA, Sun BJ, Jang JY, Yang DH, et al. Aortic valve adaptation to aortic root dilatation: insights into the mechanism of functional aortic regurgitation from 3-dimensional cardiac computed tomography. Circ Cardiovasc Imaging. 2014;7:828–35.CrossRefGoogle Scholar
  6. 6.
    Lee R, Li S, Rankin JS, O'Brien SM, Gammie JS, Peterson ED, et al. Fifteen-year outcome trends for valve surgery in North America. Ann Thorac Surg. 2011;91:677–84.CrossRefGoogle Scholar
  7. 7.
    Schubert SA, Yarboro LT, Madala S, Ayunipudi K, Kron IL, Kern JA, et al. Natural history of coexistent mitral regurgitation after aortic valve replacement. J Thorac Cardiovasc Surg. 2016;151:1032–9.CrossRefGoogle Scholar
  8. 8.
    •• Unger P, Clavel M-A, Lindman BR, Mathieu P, Pibarot P. Pathophysiology and management of multivalvular disease. Nat Rev Cardiol. 2016;13:429–40. Narrative review of the pathophysiology and treatment of left- and right-sided multivalvular disease.CrossRefGoogle Scholar
  9. 9.
    •• Zoghbi WA, Adams D, Bonow RO, Enriquez-Sarano M, Foster E, Grayburn PA, et al. Recommendations for noninvasive evaluation of native valvular regurgitation: a report from the American Society of Echocardiography developed in collaboration with the Society for Cardiovascular Magnetic Resonance. J Am Soc Echocardiogr. 2017;30:303–71. Comprehensive document detailing the strengths and limitations of echocardiography and cardiac magnetic resonance in evaluating valvular disease.CrossRefGoogle Scholar
  10. 10.
    Kilic A, Saha-Chaudhuri P, Rankin JS, Conte JV. Trends and outcomes of tricuspid valve surgery in North America: an analysis of more than 50,000 patients from the Society of Thoracic Surgeons database. Ann Thorac Surg. 2013;96:1546–52.CrossRefGoogle Scholar
  11. 11.
    Gillinov AM, Blackstone EH, Cosgrove DM 3rd, White J, Kerr P, Marullo A, et al. Mitral valve repair with aortic valve replacement is superior to double valve replacement. J Thorac Cardiovasc Surg. 2003;125:1372–87.CrossRefGoogle Scholar
  12. 12.
    Leavitt BJ, Baribeau YR, DiScipio AW, Ross CS, Quinn RD, Olmstead EM, et al. Outcomes of patients undergoing concomitant aortic and mitral valve surgery in northern new England. Circulation. 2009;120:S155–62.CrossRefGoogle Scholar
  13. 13.
    Cannegieter SC, Rosendaal FR, Wintzen AR, van der Meer FJ, Vandenbroucke JP, Briët E. Optimal oral anticoagulant therapy in patients with mechanical heart valves. N Engl J Med. 1995;333:11–7.CrossRefGoogle Scholar
  14. 14.
    •• Ando T, Takagi H, Briasoulis A, Telila T, Slovut DP, Afonso L, et al. A systematic review of reported cases of combined transcatheter aortic and mitral valve interventions. Catheter Cardiovasc Interv. 2018;91:124–34. A recent systematic review of 37 studies comprising 60 patients of combined transcatheter intervention for aortic and mitral valve disease.CrossRefGoogle Scholar
  15. 15.
    • Vollenbroich R, Stortecky S, Praz F, Lanz J, Franzone A, Zuk K, et al. The impact of functional vs degenerative mitral regurgitation on clinical outcomes among patients undergoing transcatheter aortic valve implantation. Am Heart J. 2017;184:71–80. Registry data illustrating the poor prognosis of persistent severe degenerative mitral regurgitation after TAVR for aortic stenosis.CrossRefGoogle Scholar
  16. 16.
    Nombela-Franco L, Eltchaninoff H, Zahn R, Testa L, Leon MB, Trillo-Nouche R, et al. Clinical impact and evolution of mitral regurgitation following transcatheter aortic valve replacement: a meta-analysis. Heart. 2015;101:1395–405.CrossRefGoogle Scholar
  17. 17.
    Amat-Santos IJ, Castrodeza J, Nombela-Franco L, Muñoz-García AJ, Gutiérrez-Ibanes E, de la Torre Hernández JM, et al. Tricuspid but not mitral regurgitation determines mortality after TAVI in patients with nonsevere mitral regurgitation. Rev Esp Cardiol (Engl Ed). 2018;71:357–64.CrossRefGoogle Scholar
  18. 18.
    Cortés C, Amat-Santos IJ, Nombela-Franco L, Muñoz-Garcia AJ, Gutiérrez-Ibanes E, De La Torre Hernandez JM, et al. Mitral regurgitation after transcatheter aortic valve replacement: prognosis, imaging predictors, and potential management. JACC Cardiovasc Interv. 2016;9:1603–14.CrossRefGoogle Scholar
  19. 19.
    O’Sullivan CJ, Wenaweser P. Can we predict quality of life and survival after transcatheter aortic valve replacement? Circ Cardiovasc Interv. 2015;8:e003347.CrossRefGoogle Scholar
  20. 20.
    •• Obadia JF, Messika-Zeitoun D, Leurent G, Iung B, Bonnet G, Piriou N, et al. Percutaneous repair or medical treatment for secondary mitral regurgitation. N Engl J Med. 2018.  https://doi.org/10.1056/NEJMoa1805374. Randomised data in 150 patients demonstrating similar mortality and unscheduled hospitalisation for heart failure outcomes with percutaneous edge-to-edge repair and medical therapy for moderate-severe functional mitral regurgitation compared with medical therapy alone at 1 year.CrossRefGoogle Scholar
  21. 21.
    •• Stone GW, Lindenfeld J, Abraham WT, Kar S, Lim DS, Mishell JM, et al. Transcatheter mitral-valve repair in patients with heart failure. N Engl J Med. 2018;379:2307–18. Randomised data in 614 patients with moderate-severe functional MR showing a reduction in mortality and heart failure hospitalisations with a large effect size at 2 years.CrossRefGoogle Scholar
  22. 22.
    Unger P, Lancellotti P, de Cannière D. The clinical challenge of concomitant aortic and mitral valve stenosis. Acta Cardiol. 2016;71:3–6.CrossRefGoogle Scholar
  23. 23.
    •• Joseph L, Bashir M, Xiang Q, Yerokun BA, Matsouaka RA, Vemulapalli S, et al. Prevalence and outcomes of mitral stenosis in patients undergoing transcatheter aortic valve replacement: findings from the Society of Thoracic Surgeons/American College of Cardiology Transcatheter Valve Therapies Registry. JACC Cardiovasc Interv. 2018;11:693–702. United States registry data describing combined aortic and mitral stenoses in up to 12% of patients and associated with worse clinical outcomes than isolated left-sided valvular disease.CrossRefGoogle Scholar
  24. 24.
    Vahanian A, Himbert D, Brochet E. Multiple valve disease – assessment, strategy and intervention. EuroIntervention. 2015;11(Suppl W):W14–6.CrossRefGoogle Scholar
  25. 25.
    Himbert D, Bouleti C, Iung B, Nejjari M, Brochet E, Depoix JP, et al. Transcatheter valve replacement in patients with severe mitral valve disease and annular calcification. J Am Coll Cardiol. 2014;64:2557–8.CrossRefGoogle Scholar
  26. 26.
    Tarantini G, Gasparetto V, Napodano M, Gerosa G, Isabella G. A case of combined percutaneous transfemoral mitral valvuloplasty and aortic valve implantation. J Invasive Cardiol. 2011;23:E200–1.PubMedGoogle Scholar
  27. 27.
    Pai RG, Varadarajan P. Prognostic implications of mitral regurgitation in patients with severe aortic regurgitation. Circulation. 2010;122:S43–7.CrossRefGoogle Scholar
  28. 28.
    Webb JG, Htun N. Transcatheter options for the treatment of noncalcified aortic regurgitation. JACC Cardiovasc Interv. 2015;8:1850–3.CrossRefGoogle Scholar
  29. 29.
    • Silaschi M, Conradi L, Wendler O, Schlingloff F, Kappert U, Rastan AJ, et al. The JUPITER registry: one-year outcomes of transapical aortic valve implantation using a second generation transcatheter heart valve for aortic regurgitation. Catheter Cardiovasc Interv. 2018;91:1345–51. Registry data with short-medium term follow-up for the use of a dedicated transapical valve for severe aortic regurgitation.CrossRefGoogle Scholar
  30. 30.
    Eudailey K, Hamid N, Hahn RT, Kodali S, Gray W, George I. Mitraclip followed by surgical aortic valve replacement: hybrid techniques for regurgitant aortic and mitral valve disease. Ann Thorac Surg. 2016;102:e83–5.CrossRefGoogle Scholar
  31. 31.
    Kische S, D'Ancona G, Paranskaya L, Schubert J, Arsoy N, Hauenstein KH, et al. Staged total percutaneous treatment of aortic valve pathology and mitral regurgitation: institutional experience. Catheter Cardiovasc Interv. 2013;82:E552–63.PubMedGoogle Scholar
  32. 32.
    • Del Val D, Regueiro A, Rodríguez-Gabella T, Paradis JM, Puri R, Rodés-Cabau J. Concomitant or staged transcatheter treatment for severe combined aortic and mitral valve disease. Rev Esp Cardiol (Engl Ed). 2018;71:676–9. Systematic review describing the safety and feasibility of combined transcatheter intervention for severe aortic stenosis and mitral regurgitation.CrossRefGoogle Scholar
  33. 33.
    Nguyen V, Cimadevilla C, Estellat C, Codogno I, Huart V, Benessiano J, et al. Haemodynamic and anatomic progression of aortic stenosis. Heart. 2015;101:943–7.CrossRefGoogle Scholar
  34. 34.
    Patel R, Kamath A, Varadarajan P, Krishnan S, Pai RG. Slow rate of progression of grade 1 and 2+ aortic regurgitation. J Heart Valve Dis. 2012;21:328–30.PubMedGoogle Scholar
  35. 35.
    Bissessor N, Shanahan L, Wee YS, Stewart R, Lowe B, Kerr A, et al. The role of natriuretic peptides in patients with chronic complex (mixed or multiple) heart valve disease. Congest Heart Fail. 2010;16:50–4.CrossRefGoogle Scholar
  36. 36.
    Baumgartner H, Falk V, Bax JJ, De Bonis M, Hamm C, Holm PJ, et al. 2017 ESC/EACTS Guidelines for the management of valvular heart disease. Eur Heart J. 2017;38:2739–91.CrossRefGoogle Scholar
  37. 37.
    Vahanian A, Alfieri O, Andreotti F, Antunes MJ, Barón-Esquivias G, Baumgartner H, et al. Guidelines on the management of valvular heart disease (version 2012): the Joint Task Force on the Management of Valvular Heart Disease of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS). Eur J Cardiothorac Surg. 2012;42:S1–44.CrossRefGoogle Scholar
  38. 38.
    • Alame AJ, Karatasakis A, Karacsonyi J, Danek BA, Sorajja P, Gössl M, et al. Comparison of the American College of Cardiology/American Heart Association and the European Society of Cardiology Guidelines for the Management of Patients With Valvular Heart Disease. J Invasive Cardiol. 2017;29:320–6. A paper describing both North American and European valvular disease management guidelines and focussing on their differences.PubMedGoogle Scholar
  39. 39.
    Nishimura RA, Otto CM, Bonow RO, Carabello BA, Erwin JP 3rd, Fleisher LA, et al. AHA/ACC Focused Update of the 2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol. 2017;70:252–89.CrossRefGoogle Scholar
  40. 40.
    Sampaio RO, Paixão MR, Miranda TT, Veronese ET, Palma JHA, Tarasoutchi F. Combined mitral and aortic valvar bioprosthesis transcatheter transapical implant: first description in Brazil. Arq Bras Cardiol. 2017;109:491–4.PubMedPubMedCentralGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Rodney De Palma
    • 1
    Email author
  • Crochan J. O’Sullivan
    • 1
  • Magnus Settergren
    • 1
  1. 1.Heart and Vascular ThemeKarolinska University Hospital and Karolinska InstitutetStockholmSweden

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