81 Y/O MAN · East Carolina Heart Institute • EF 0.60 • ESD 40 mm • BNP: 360 • STS FOR...
Transcript of 81 Y/O MAN · East Carolina Heart Institute • EF 0.60 • ESD 40 mm • BNP: 360 • STS FOR...
East Carolina Heart Institute
81 Y/O MAN
• PROGRESSIVE DOE
• 3/6 HOLOSYSTOLIC MURMUR; 2/6 RSB MID-DIASTOLIC MURMUR
East Carolina Heart Institute
East Carolina Heart Institute
East Carolina Heart Institute
• EF 0.60
• ESD 40 mm
• BNP: 360
• STS FOR MVRe: 1.6%
East Carolina Heart Institute
REGARDING HIS AR
• HE SHOULD UNDERGO MVRe +AVR
• WE SHOULD ONLY REPAIR THE MITRAL VALVE
• REPAIR THE MITRAL VALVE NOW; TAVR LATER
East Carolina Heart Institute
WILL THE AR PROGRESS?
East Carolina Heart Institute
DAVIS SM / Aviation, Space, and Environmental Medicine 2014
4
East Carolina Heart Institute
VATURI et al JACC 1999
• 59 PATIENTS WITH NON SURGICAL AORITC VALVE DISEASE AT THE TIME OF MITRAL Sx
• FOLLOWED FOR 13 YEARS
• 1 REQUIRED AVR 16 YEARS LATER
East Carolina Heart Institute
PADIAL et al ; AJC 1997
PADIAL et al
• 127 PATIENTS WITH SOME DEGREE OF AR
• FOLLOWED FOR 20 MONTHS
East Carolina Heart Institute
AR PROG
NONE1,22,3
East Carolina Heart Institute
Heart Valve Dis. 2013 Mar;22(2):192-4.. Weisenberg D et al262 consecutive patients with moderate ARFollowed 42 +/- 31 months. RESULTS:Progression to severe AR occurred in 18 patients (6.9%), an average progression rate of 1.9% per year. aortic dilatation had a significantly higher rate of progression to severe AR (9/70; 3.7%/year) compared to those with leaflet path. Only three patients were referred for aortic valve replacement during follow up.
East Carolina Heart Institute
CHOUDHARY et al JTCVS 2001
East Carolina Heart Institute
MOST MV SURGERY DONE FOR MR MAKING IMPACT OF
AR HARD TO ASSESS
East Carolina Heart Institute
PROGRESSION TO SEVERE AR IS SLOW
• ABOUT 2%/ YEAR
• PERHAPS DOUBLE WHEN THE AORTIC ROOT IS ENLARGED
East Carolina Heart Institute
East Carolina Heart Institute
Early safety at 30 days 50/76 (66%) 55/61 (90%) 0.002
All-cause mortality 11/77 (14%) 1/66 (2%) 0.015
All stroke 3/76 (4%) 1/65 (2%) 0.726
Major vascular complications 6/77 (8%) 2/68 (3%) 0.362
Life-threatening bleeding 2/76 (3%) 2/65 (3%) 1.000
Acute kidney injury stage ≥2 8/76 (11%) 1/61 (2%) 0.082
Coronary artery obstruction requiring intervention
0/77 (0%) 0/65 (0%) 1.000
Repeat procedure for valve-related dysfunction
2/77 (3%)
NATIVE VIV
SAWAYA, JACC INT 2017
East Carolina Heart InstituteSeiffert ET AL JACC INT 2014
East Carolina Heart Institute
DEALER’S CHOICE
• MILD SIDE OF MODERATE: LEAVE IT
• SEVERE SIDE OF MODERATE (ESP WITH Ao ROOT ENLARGEMENT, FIX IT
• IT SEEMS LIKELY THAT TAVR WILL BE AN OPTION
East Carolina Heart Institute
OUR PATIENT
• UNEVENTFUL MVRe
• ASYMPTOMATIC; BACK PLAYING GOLF
• 2 YEARS POST OP STILL MOD AR