SANNINO, ANNA (2018) IMPACT OF CALCIFIC MITRAL STENOSIS ON SURVIVAL IN PATIENTS UNDERGOING TRANSCATHETER AORTIC VALVE REPLACEMENT. [Tesi di dottorato]
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| Item Type: | Tesi di dottorato |
|---|---|
| Resource language: | English |
| Title: | IMPACT OF CALCIFIC MITRAL STENOSIS ON SURVIVAL IN PATIENTS UNDERGOING TRANSCATHETER AORTIC VALVE REPLACEMENT |
| Creators: | Creators Email SANNINO, ANNA anna.sannino@icloud.com |
| Date: | 3 December 2018 |
| Number of Pages: | 28 |
| Institution: | Università degli Studi di Napoli Federico II |
| Department: | Scienze Biomediche Avanzate |
| Dottorato: | Medicina clinica e sperimentale |
| Ciclo di dottorato: | 31 |
| Coordinatore del Corso di dottorato: | nome email BEGUINOT, FRANCESCO UNSPECIFIED |
| Tutor: | nome email TRIMARCO, BRUNO UNSPECIFIED |
| Date: | 3 December 2018 |
| Number of Pages: | 28 |
| Keywords: | mitral stenosis; aortic valve |
| Settori scientifico-disciplinari del MIUR: | Area 06 - Scienze mediche > MED/11 - Malattie dell'apparato cardiovascolare |
| Date Deposited: | 19 Dec 2018 12:45 |
| Last Modified: | 30 Jun 2020 08:48 |
| URI: | http://www.fedoa.unina.it/id/eprint/12463 |
Collection description
Objectives. This study was performed to investigate the prevalence and impact on survival of baseline calcific mitral stenosis (MS) in patients undergoing transcatheter aortic valve replacement (TAVR) due to the presence of severe symptomatic aortic stenosis (AS). Methods. This retrospective study included 928 consecutive patients with severe, symptomatic AS undergoing TAVR in two institutions, from January 2012 to August 2016. Mean follow-up was 40.8±13.9 months. Results. Based on mean mitral gradients (MMG) at baseline, 3 groups were identified: normal-mild, MMG<5 mmHg (n=737, 81.7%); moderate MMG5 and <10 mmHg (n=147, 16.3%); severe MMG10 mmHg (n=17, 1.9%). These latter were more frequently women, with a smaller body surface area, a higher prevalence of atrial fibrillation, chronic obstructive pulmonary disease and previous history of CABG/PCI. At baseline, patients with MMG10 mmHg compared with 5 and <10 mmHg and normal patients exhibited a lower mitral valve area (2.4±0.94 vs 2.1±0.86 vs 1.5±0.44 cm2) a lower prevalence of MR2+ (5.9% vs 28.6% and 15.6%, p<0.0001), a higher prevalence of severe mitral annular calcium (70.6% vs 45.6% and 13.0%, p<0.0001) and a higher systolic pulmonary arterial pressure (50.6±12.1 vs 47.2±14.5 and 41.6±14.4, p<0.0001). Despite the low prevalence of MMG10 mmHg, these patients experienced higher 5-year mortality compared to the other groups (adjusted Hazard Ratio: 2.91, 95% Confidence Interval [CI]:1.17-7.20, p=0.02). Conclusions. Severe calcific MS is uncommon in patients undergoing TAVR. However, its presence is associated with higher long-term mortality whereas moderate MS is not. The presence of severe calcific MS might identify a subgroup of patients in whom a double valve intervention should be considered.
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