Transcatheter Aortic Valve Replacement in Patients With Multivalvular Heart Disease.

Khan, Faisal; Okuno, Taishi; Malebranche, Daniel; Lanz, Jonas; Praz, Fabien; Stortecky, Stefan; Windecker, Stephan; Pilgrim, Thomas (2020). Transcatheter Aortic Valve Replacement in Patients With Multivalvular Heart Disease. JACC. Cardiovascular Interventions, 13(13), pp. 1503-1514. Elsevier 10.1016/j.jcin.2020.03.052

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As transcatheter aortic valve replacement becomes a more dominant treatment option across all risk profiles, the frequency of encountering patients with multivalvular disease will increase. Furthermore, percutaneous interventions to treat other valvular lesions are also evolving. Understanding the clinical implications and treatment options for a second valvular lesion is becoming increasingly important to guide heart team decisions, and this paper aims to review the evidence around these situations. Diagnosis of multivalvular disease can be challenging because of changes in physiology. There are little randomized data to guide therapy in multivalvular disease. Multidisciplinary heart team decisions can be invaluable in integrating the plethora of clinical, hemodynamic, and imaging data on which an optimal management strategy can be planned. Prospective studies to assess the role of structural valve interventions in the transcatheter aortic valve replacement era would greatly help improve outcomes for structural heart patients.

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