81 Y/O MAN · East Carolina Heart Institute • EF 0.60 • ESD 40 mm • BNP: 360 • STS FOR MVRe: 1.6%

East Carolina Heart Institute

81 Y/O MAN

• PROGRESSIVE DOE

• 3/6 HOLOSYSTOLIC MURMUR; 2/6 RSB MID-DIASTOLIC MURMUR




• EF 0.60

• ESD 40 mm

• BNP: 360

• STS FOR MVRe: 1.6%


REGARDING HIS AR

• HE SHOULD UNDERGO MVRe +AVR

• WE SHOULD ONLY REPAIR THE MITRAL VALVE

• REPAIR THE MITRAL VALVE NOW; TAVR LATER


WILL THE AR PROGRESS?


DAVIS SM / Aviation, Space, and Environmental Medicine 2014

4


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


PADIAL et al ; AJC 1997

PADIAL et al

• 127 PATIENTS WITH SOME DEGREE OF AR

• FOLLOWED FOR 20 MONTHS


AR PROG

NONE1,22,3


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.


CHOUDHARY et al JTCVS 2001


MOST MV SURGERY DONE FOR MR MAKING IMPACT OF

AR HARD TO ASSESS


PROGRESSION TO SEVERE AR IS SLOW

• ABOUT 2%/ YEAR

• PERHAPS DOUBLE WHEN THE AORTIC ROOT IS ENLARGED



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


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


OUR PATIENT

• UNEVENTFUL MVRe

• ASYMPTOMATIC; BACK PLAYING GOLF

• 2 YEARS POST OP STILL MOD AR

Documents

81 Y/O MAN · East Carolina Heart Institute • EF 0.60 • ESD 40 mm • BNP: 360 • STS FOR MVRe: 1.6%