Transcatheter Treatment for Combined Aortic and Mitral Valve Disease Studied in AMTRAC Registry

December 8, 2020—Findings from an evaluation of transcatheter treatment of residual significant mitral regurgitation (MR) after transcatheter aortic valve replacement (TAVR) in the multicenter AMTRAC registry of the transcatheter treatment for combined aortic and mitral valve disease.

Guy Witberg, MD, et al published the study results in Journal of the American College of Cardiology (JACC): Cardiovascular Interventions (2020;13:2782-2791). An accompanying editorial commentary was published by Carlos Cortés in JACC: Cardiovascular Interventions (2020;13:2792–2794).

Management of patients with combined valvular disease is challenging, and until recently, double-valve surgery was the only option for treating patients with aortic stenosis plus MR. Witberg et al sought to describe baseline characteristics and periprocedural and midterm outcomes of patients undergoing transcatheter mitral valve interventions after TAVR and examine their clinical benefit. The international AMTRAC registry enrolled 24,178 patients at 23 TAVR centers.

The investigators concluded that for patients who continue to have significant MR, remain symptomatic post-TAVR, and are anatomically suitable for transcatheter interventions, these procedures are feasible, safe, and associated with significant improvement in MR grade and NYHA functional class. These results apply mainly to PMVR. A staged PMVR strategy was associated with markedly lower mortality, but this was not statistically significant, advised the investigators in JACC: Cardiovascular Interventions.

In the editorial in JACC: Cardiovascular Interventions, Dr. Cortés commented, "The safety of a percutaneous approach for patients with previous cardiac surgery has been shown, and despite the lack of evidence, it makes sense that prior percutaneous intervention will not affect possible future cardiac surgery, as the main risk for reintervention is due to injury to adherent cardiac structures, leading to bleeding during redo sternotomy. For this reason, starting treatment for multivalvular disease with a percutaneous approach if clinical, anatomic, and technical features are favorable seems to be a safe option without risk for jeopardizing future interventions. Such a percutaneous multivalve treatment approach for selected patients should produce ongoing and steady advances in the field."