Structural heart transcatheter interventions in orthotopic cardiac transplant and left ventricular assist devices recipients: A nationwide study.

Autores de IIS La Fe

• Víctor José Donoso Trenado

  Autor

• Jorge Sanz Sánchez

  Autor

Participantes ajenos a IIS La Fe

• Blasco-Turrión, S
• Crespo-Leiro, MG
• Chi Hion, Pedro Li
• Diaz Molina, Beatriz
• Roura, G
• Alvarez-Osorio, MP
• Gómez-bueno, M
• Ortiz Bautista, Carlos
• Diaz, JF
• Garrido Bravo, Iris Paula
• Moreno, R
• Sarnago-Cebada, F
• Salterain Gonzalez, Nahikari
• de la Torre Hernandez, Jose M.
• Garcia Del Blanco, Bruno
• Farrero, M
• Ortas Nadal, Rosario
• Martin, P
• de la Fuente, L
• Mirabet Perez, Sonia
• Alonso Fernandez, Vanesa
• Gomez Hospital, Joan Antoni
• Lopez Granados, Amador
• Couto-Mallon, D
• del Trigo Espinosa, Maria
• Rangel Sousa, Diego
• Zatarain-Nicolás, E
• Arzamendi Aizpurua, Dabit
• Lopez Vilella, Raquel
• San Roman, J Alberto
• Amat-Santos, IJ

Grupos

• Grupo de Investigación Clínica y Traslacional en Cardiología

Abstract

BACKGROUND: The current incidence and outcomes of structural transcatheter procedures in heart transplant (HTx) recipients and left-ventricular assist devices (LVAD) carriers is unknown. AIMS: To provide insights on structural transcatheter procedures performed across HTx and LVAD patients in Spain. METHODS: Multicenter, ambispective, observational nationwide registry. RESULTS: Until May/2023, 36 percutaneous structural interventions were performed (78% for HTx and 22% for LVAD) widely varying among centers (0%-1.4% and 0%-25%, respectively). Percutaneous mitral transcatheter edge-to-edge (TEER) was the most common (n = 12, 33.3%), followed by trancatheter aortic valve replacement (n = 11, 30.5%), and tricuspid procedures (n = 9, 25%). Mitral TEER resulted in mild residual mitral regurgitation in all but one case, mean gradient was <5 mmHg in 75% of them at 1-year, with no mortality and 8.3% re-admission rate. Tricuspid TEER resulted in 100% none/mild residual regurgitation with a 1-year mortality and readmission rates of 22% and 28.5%, respectively. Finally, trancatheter aortic valve replacement procedures (n = 8 in LVADs due to aortic regurgitation and n = 3 in HTx), were successful in all cases with one prosthesis degeneration leading to severe aortic regurgitation at 1-year, 18.2% mortality rate and no re-admissions. Globally, major bleeding rates were 7.9% and 12.5%, thromboembolic events 3.7% and 12.5%, readmissions 37% and 25%, and mortality 22% and 25%, in HTx and LVADs respectively. No death was related to the implanted transcatheter device. CONCLUSIONS: Most centers with HTx/LVAD programs perform structural percutaneous procedures but with very inconsistent incidence. They were associated with good safety and efficacy, but larger studies are required to provide formal recommendations.

Copyright © 2024 Elsevier B.V. All rights reserved.

Keywords

• Heart transplant; LVAD; Percutaneous therapies. TAVI. TEER. CAVI. LAAO