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...
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East Carolina Heart Institute
81 Y/O MAN
• PROGRESSIVE DOE
• 3/6 HOLOSYSTOLIC MURMUR; 2/6 RSB MID-DIASTOLIC MURMUR
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East Carolina Heart Institute
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East Carolina Heart Institute
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East Carolina Heart Institute
• EF 0.60
• ESD 40 mm
• BNP: 360
• STS FOR MVRe: 1.6%
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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
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East Carolina Heart Institute
WILL THE AR PROGRESS?
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East Carolina Heart Institute
DAVIS SM / Aviation, Space, and Environmental Medicine 2014
4
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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
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East Carolina Heart Institute
PADIAL et al ; AJC 1997
PADIAL et al
• 127 PATIENTS WITH SOME DEGREE OF AR
• FOLLOWED FOR 20 MONTHS
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East Carolina Heart Institute
AR PROG
NONE1,22,3
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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.
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East Carolina Heart Institute
CHOUDHARY et al JTCVS 2001
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East Carolina Heart Institute
MOST MV SURGERY DONE FOR MR MAKING IMPACT OF
AR HARD TO ASSESS
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East Carolina Heart Institute
PROGRESSION TO SEVERE AR IS SLOW
• ABOUT 2%/ YEAR
• PERHAPS DOUBLE WHEN THE AORTIC ROOT IS ENLARGED
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East Carolina Heart Institute
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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
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East Carolina Heart InstituteSeiffert ET AL JACC INT 2014
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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
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East Carolina Heart Institute
OUR PATIENT
• UNEVENTFUL MVRe
• ASYMPTOMATIC; BACK PLAYING GOLF
• 2 YEARS POST OP STILL MOD AR