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Impact of Transcatheter Aortic Valve Implantation Among Patients With Co-existing Mild to Moderate Mitral Regurgitation

      A subset of patients with severe aortic stenosis (AS) who are who underwent transcatheter aortic valve implantation (TAVI) also has mitral regurgitation (MR). Clinical outcomes in these patients with combined MR and AS have varied. The purpose of this study was to assess clinical outcomes and echocardiographic outcomes after TAVI in patients with preprocedural MR. A retrospective chart review from March 2018 to June 2020 identified all TAVI patients. Patients were assigned an MR class of mild, moderate, or severe based upon pre-TAVI transthoracic echocardiogram (TTE). Patients were excluded if they were discharged from the hospital and did not have a 6-month follow-up after TAVI. Clinical outcomes at 6 months included all-cause mortality, major adverse cardiovascular events, clinically significant bleeding, changes in ejection fraction (EF) category, and changes in MR severity. Of 118 included patients (age 76 ± 10 years, 79% male, 46% White), 33% had MR, with 26% being mild and 7% moderate MR. Before TAVI, AS + MR patients were more likely to have a reduced EF (<50%) by category compared with those with AS only (33.3% vs 8.8%, p = 0.01) but were more likely to show an increase in EF by category after TAVI (19.4% vs 5.5%, p = 0.039). No significant differences were observed between the 2 groups in terms of all-cause mortality (12.8 vs 5.1%, p = 0.14), major adverse cardiovascular events (17.9 vs 8.9%, p = 0.15), or clinically significant bleeding (10.3 vs 6.3%, p = 0.45). Patients with AS and co-existing MR experienced similar clinical outcomes at 6 months to those with AS only after TAVI. They were more likely to show increases in EF category 6 months after valve implantation. Our results support the conclusion that in addition to treating the aortic valve, TAVI also potentially benefits left ventricular function in the setting of mild or moderate MR.
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      References

        • Smith CR
        • Leon MB
        • Mack MJ
        • Miller DC
        • Moses JW
        • Svensson LG
        • Tuzcu EM
        • Webb JG
        • Fontana GP
        • Makkar RR
        • Williams M
        • Dewey T
        • Kapadia S
        • Babaliaros V
        • Thourani VH
        • Corso P
        • Pichard AD
        • Bavaria JE
        • Herrmann HC
        • Akin JJ
        • Anderson WN
        • Wang D
        • Pocock SJ
        • PARTNER Trial Investigators
        Transcatheter versus surgical aortic-valve replacement in high-risk patients.
        N Engl J Med. 2011; 364: 2187-2198
        • Webb JG
        • Altwegg L
        • Boone RH
        • Cheung A
        • Ye J
        • Lichtenstein S
        • Lee M
        • Masson JB
        • Thompson C
        • Moss R
        • Carere R
        • Munt B
        • Nietlispach F
        • Humphries K.
        Transcatheter aortic valve implantation: impact on clinical and valve-related outcomes.
        Circulation. 2009; 119: 3009-3016
        • Leon MB
        • Smith CR
        • Mack MJ
        • Makkar RR
        • Svensson LG
        • Kodali SK
        • Thourani VH
        • Tuzcu EM
        • Miller DC
        • Herrmann HC
        • Doshi D
        • Cohen DJ
        • Pichard AD
        • Kapadia S
        • Dewey T
        • Babaliaros V
        • Szeto WY
        • Williams MR
        • Kereiakes D
        • Zajarias A
        • Greason KL
        • Whisenant BK
        • Hodson RW
        • Moses JW
        • Trento A
        • Brown DL
        • Fearon WF
        • Pibarot P
        • Hahn RT
        • Jaber WA
        • Anderson WN
        • Alu MC
        • Webb JG
        PARTNER 2 Investigators. Transcatheter or surgical aortic-valve replacement in intermediate-risk patients.
        N Engl J Med. 2016; 374: 1609-1620
        • Mack MJ
        • Leon MB
        • Thourani VH
        • Makkar R
        • Kodali SK
        • Russo M
        • Kapadia SR
        • Malaisrie SC
        • Cohen DJ
        • Pibarot P
        • Leipsic J
        • Hahn RT
        • Blanke P
        • Williams MR
        • McCabe JM
        • Brown DL
        • Babaliaros V
        • Goldman S
        • Szeto WY
        • Genereux P
        • Pershad A
        • Pocock SJ
        • Alu MC
        • Webb JG
        • Smith CR
        • PARTNER 3 Investigators
        Transcatheter aortic-valve replacement with a balloon-expandable valve in low-risk patients.
        N Engl J Med. 2019; 380: 1695-1705
        • Freitas-Ferraz AB
        • Lerakis S
        • Ribeiro H
        • Gilard M
        • Cavalcante JL
        • Makkar R
        • Herrmann HC
        • Windecker S
        • Enrique-Sarano M
        • Cheema AN
        • Nombela-Franco L
        • Amat-Santos I
        • Muñoz-García AJ
        • Garcia del Blanco B
        • Zajarias A
        • Lisko JC
        • Hayek S
        • Babaliaros V
        • Le Ven FL
        • Gleason TG
        • Chakravarty T
        • Szeto WY
        • Clavel MA
        • de Agustin A
        • Serra V
        • Schindler JT
        • Dahou A
        • Annabi MS
        • Pelletier-Beaumont E
        • Pibarot P
        • Rodés-Cabau J
        Mitral regurgitation in low-flow, low-gradient aortic stenosis patients undergoing TAVR.
        JACC Cardiovasc Interv. 2020; 13: 567-579
        • Sannino A
        • Losi MA
        • Schiattarella GG
        • Gargiulo G
        • Perrino C
        • Stabile E
        • Toscano E
        • Giugliano G
        • Brevetti L
        • Franzone A
        • Cirillo P
        • Imbriaco M
        • Trimarco B
        • Esposito G.
        Meta-analysis of mortality outcomes and mitral regurgitation evolution in 4,839 patients having transcatheter aortic valve implantation for severe aortic stenosis.
        Am J Cardiol. 2014; 114: 875-882
        • Nombela-Franco L
        • Eltchaninoff H
        • Zahn R
        • Testa L
        • Leon MB
        • Trillo-Nouche R
        • D'Onofrio A
        • Smith CR
        • Webb J
        • Bleiziffer S
        • De Chiara B
        • Gilard M
        • Tamburino C
        • Bedogni F
        • Barbanti M
        • Salizzoni S
        • García del Blanco B
        • Sabaté M
        • Moreo A
        • Fernández C
        • Ribeiro HB
        • Amat-Santos I
        • Urena M
        • Allende R
        • García E
        • Macaya C
        • Dumont E
        • Pibarot P
        • Rodés-Cabau J
        Clinical impact and evolution of mitral regurgitation following transcatheter aortic valve replacement: a meta-analysis.
        Heart. 2015; 101: 1395-1405
        • Toggweiler S
        • Boone RH
        • Rodés-Cabau J
        • Humphries KH
        • Lee M
        • Nombela-Franco L
        • Bagur R
        • Willson AB
        • Binder RK
        • Gurvitch R
        • Grewal J
        • Moss R
        • Munt B
        • Thompson CR
        • Freeman M
        • Ye J
        • Cheung A
        • Dumont E
        • Wood DA
        • Webb JG.
        Transcatheter aortic valve replacement: outcomes of patients with moderate or severe mitral regurgitation.
        J Am Coll Cardiol. 2012; 59: 2068-2074
        • Chakravarty T
        • Van Belle EV
        • Jilaihawi H
        • Noheria A
        • Testa L
        • Bedogni F
        • Rück A
        • Bartanti M
        • Toggweiler S
        • Thomas M
        • Khawaja MZ
        • Hutter A
        • Abramowitz Y
        • Siegal RJ
        • Cheng W
        • Webb J
        • Leon MB
        • Makkar RR.
        Meta-analysis of the impact of mitral regurgitation on outcomes after transcatheter aortic valve implantation.
        Am J Cardiol. 2015; 115: 942-949
        • Barbanti M
        • Webb JG
        • Hahn RT
        • Feldman T
        • Boone RH
        • Smith CR
        • Kodali S
        • Zajarias A
        • Thompson CR
        • Green P
        • Babaliaros V
        • Makkar RR
        • Szeto WY
        • Douglas PS
        • McAndrew T
        • Hueter I
        • Miller DC
        • Leon MB
        Placement of Aortic Transcatheter Valve Trial Investigators. Impact of preoperative moderate/severe mitral regurgitation on 2-year outcome after transcatheter and surgical aortic valve replacement: insight from the Placement of Aortic Transcatheter Valve (PARTNER) Trial Cohort A.
        Circulation. 2013; 128: 2776-2784
        • D'Onofrio A
        • Gasparetto V
        • Napodano M
        • Bianco R
        • Tarantini G
        • Renier V
        • Isabella G
        • Gerosa G.
        Impact of preoperative mitral valve regurgitation on outcomes after transcatheter aortic valve implantation.
        Eur J Cardiothorac Surg. 2012; 41: 1271-1276
        • Mitchell C
        • Rahko PS
        • Blauwet LA
        • Canaday B
        • Finstuen JA
        • Foster MC
        • Horton K
        • Ogunyankin KO
        • Palma RA
        • Velazquez EJ.
        Guidelines for performing a comprehensive transthoracic echocardiographic examination in adults: recommendations from the American Society of Echocardiography.
        J Am Soc Echocardiogr. 2019; 32: 1-64
        • Kappetein AP
        • Head SJ
        • Généreux P
        • Piazza N
        • van Mieghem NM
        • Blackstone EH
        • Brott TG
        • Cohen DJ
        • Cutlip DE
        • van Es GA
        • Hahn RT
        • Kirtane AJ
        • Krucoff MW
        • Kodali S
        • Mack MJ
        • Mehran R
        • Rodés-Cabau J
        • Vranckx P
        • Webb JG
        • Windecker S
        • Serruys PW
        • Leon MB
        Valve Academic Research Consortium-2. Updated standardized endpoint definitions for transcatheter aortic valve implantation: the Valve Academic Research Consortium-2 consensus document.
        J Thorac Cardiovasc Surg. 2013; 145: 6-23
        • Hutter A
        • Bleiziffer S
        • Richter V
        • Opitz A
        • Hettich I
        • Mazzitelli D
        • Ruge H
        • Lange R.
        Transcatheter aortic valve implantation in patients with concomitant mitral and tricuspid regurgitation.
        Ann Thorac Surg. 2013; 95: 77-84
        • Abdullah O
        • Omran J
        • Al-Dadah A
        • Enezate T.
        Outcomes of transcatheter aortic valve replacement in patients with mitral valve regurgitation.
        Postepy Kardiol Interwencyjnej. 2019; 15: 187-194
        • Itabashi Y
        • Shibayama K
        • Mihara H
        • Utsunomiya H
        • Berdejo J
        • Arsanjani R
        • Siegel R
        • Chakravarty T
        • Jilaihawi H
        • Makkar RR
        • Shiota T.
        Significant reduction in mitral regurgitation volume is the main contributor for increase in systolic forward flow in patients with functional mitral regurgitation after transcatheter aortic valve replacement: hemodynamic analysis using echocardiography.
        Echocardiography. 2015; 32: 1621-1627
        • Giordana F
        • Capriolo M
        • Frea S
        • Marra WG
        • Giorgi M
        • Bergamasco L
        • Omedè PL
        • Sheiban I
        • D'Amico M
        • Bovolo V
        • Salizzoni S
        • La Torre M
        • Rinaldi M
        • Marra S
        • Gaita F
        • Morello M
        Impact of TAVI on mitral regurgitation: A prospective echocardiographic study.
        Echocardiography. 2013; 30: 250-257