Performing TAVR and TMVR during the same hospitalization may provide value
As one might expect, patients who undergo transcatheter aortic valve replacement (TAVR) and transcatheter mitral valve replacement (TMVR) during the same hospitalization tend to be sicker and present with more comorbidities than patients who just undergo just TMVR. However, according to new findings published in the American Journal of Cardiology, those patients do not necessarily face an elevated risk of mortality.
Noting that some TAVR patients present with concomitant moderate to severe mitral regurgitation, the study’s authors hoped to learn more about how combining the two procedures affects patient outcomes.
“In high-risk patients with concomitant aortic stenosis and mitral regurgitation, combined TAVR and TMVR may be a feasible approach; however, data on the outcomes of combined TAVR and TMVR are limited to case reports,” wrote first author Agam Bansal, MD, from the department of cardiovascular medicine at Cleveland Clinic, and colleagues. “Therefore, we aimed to perform a nationwide cohort to assess the incidence and outcomes of patients who underwent combined TAVR and TMVR during the same hospitalization.”
Bansal et al. explored the Nationwide Readmission Database, focusing on more than 2,500 TMVR patients treated from 2016 to 2018. A total of 137 patients with a median age of 74 years old underwent TAVR and TMVR during the same hospitalization. Those patients presented with “significantly higher comorbidities,” including much higher rates of end-stage renal disease (13.1% vs. 4.8%). After making specific adjustments for patient and hospital characteristics, however, these patients were not associated with a significantly higher risk of mortality, new dialysis requirements, stroke, sepsis, blood transfusion or cardiac tamponade.
“Our study highlights an important point that the outcomes with combined TMVR and TAVR during the same hospitalization are acceptable, especially given the severity of their disease condition,” the authors wrote. “Unlike TAVR, the experience with TMVR is at an early stage primarily because of challenges of valve deployment and complications such as valve deployment and subsequent left ventricular outflow tract obstruction. However, with increasing operator experience, the outcomes of TMVR alone and of combined TMVR and TAVR are expected to improve.”
The full study is available here.
Michael has more than 18 years of experience as a professional writer and editor. He has written at length about cardiology, radiology, artificial intelligence and other key healthcare topics.