Related Experiment Video
Updated: Feb 21, 2026
A Simplified Stepwise Approach to Echo Guidance during Percutaneous Mitral Valve Repair
Published on: October 16, 2021
Prosthetic Mitral Surgical Valve in Transcatheter Aortic Valve Replacement Recipients: A Multicenter Analysis
Ignacio J Amat-Santos1, Carlos Cortés2, Luis Nombela Franco3
1CIBERCV, Hospital Clínico Universitario, Valladolid, Spain.
Objectives:
The aim of this study was to determine the prognosis and specific complications of patients with prosthetic mitral valves (PMVs) undergoing transcatheter aortic valve replacement (TAVR).
Background:
TAVR is performed relatively often in patients with PMVs, but specific risks are not well described.
Methods:
A multicenter analysis was conducted, including patients with severe symptomatic aortic stenosis who underwent TAVR at 10 centers. Patients' clinical characteristics and outcomes were evaluated according to the presence of a PMV.
Results:
The mean age of the study population (n = 2,414) was 81 ± 8 years, and 48.8% were men. A total of 91 patients (3.77%) had PMVs. They were more commonly women, younger, and had higher surgical risk. PMVs were implanted a median of 14 years before TAVR, and most patients had mechanical prostheses (73.6%). Eighty-six patients (94.5%) were on long-term vitamin K inhibitor therapy, and bridging antithrombotic therapy was administered in 59 (64.8%). TAVR device embolization occurred in 6.7% (vs. 3.3% in the non-PMV group; p = 0.127), in all instances when distance between the PMV and the aortic annulus was <7 mm. Mortality rates did not show a difference, but the rate of bleeding was higher in patients with PMV (24.2% vs. 16.1%; p = 0.041), even in those treated via the transfemoral approach (22.2% vs. 13.9%; p = 0.048). Indeed, bleeding complications, prior atrial fibrillation, chronic obstructive pulmonary disease, surgical risk, and New York Heart Association functional class were independent predictors of mortality.
Conclusions:
TAVR presents similar mortality irrespective of the presence of a PMV. However, patients with PMVs had higher bleeding risk that was independently associated with higher mortality. Risk for valve embolization was relatively high, but it occurred only in patients with PMV-to-aortic annulus distances <7 mm.
Insights
Transcatheter aortic valve replacement (TAVR) in patients with prosthetic mitral valves (PMVs) shows similar mortality but increased bleeding risk. Careful assessment of PMV-to-aortic annulus distance is crucial to mitigate TAVR device embolization.
Area of Science:
- Cardiology
- Interventional Cardiology
- Cardiac Surgery
Background:
- Transcatheter aortic valve replacement (TAVR) is increasingly performed in patients with prosthetic mitral valves (PMVs).
- Specific risks and outcomes associated with TAVR in this population are not well-defined.
- Understanding these risks is crucial for optimizing patient care and procedural success.
Purpose of the Study:
- To determine the prognosis and specific complications of patients with PMVs undergoing TAVR.
- To evaluate the impact of PMVs on TAVR outcomes, including mortality, bleeding, and device embolization.
- To identify predictors of mortality in patients with PMVs undergoing TAVR.
Main Methods:
- Multicenter analysis of 2,414 patients with severe symptomatic aortic stenosis undergoing TAVR.
- Comparison of clinical characteristics and outcomes between patients with and without PMVs.
- Evaluation of TAVR device embolization, mortality, and bleeding rates, with subgroup analysis for transfemoral approach.
Main Results:
- 91 patients (3.77%) had PMVs; they were more likely to be women, younger, and have higher surgical risk.
- TAVR device embolization occurred in 6.7% of PMV patients, exclusively when PMV-to-aortic annulus distance was <7 mm.
- Patients with PMVs had higher bleeding rates (24.2% vs. 16.1%), which independently predicted mortality.
Conclusions:
- TAVR demonstrates similar mortality rates in patients with or without PMVs.
- Increased bleeding risk in PMV patients undergoing TAVR is independently associated with higher mortality.
- TAVR device embolization risk is confined to cases with a narrow PMV-to-aortic annulus distance (<7 mm).
Related Concept Videos
01:26Mitral Stenosis III: Medical Management
01:25Mitral Regurgitation III: Medical Management
01:22Mitral Valve Prolapse II: Assessment and Management