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.
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to American Journal of CardiologyAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Transcatheter versus surgical aortic-valve replacement in high-risk patients.N Engl J Med. 2011; 364: 2187-2198
- Transcatheter aortic valve implantation: impact on clinical and valve-related outcomes.Circulation. 2009; 119: 3009-3016
- PARTNER 2 Investigators. Transcatheter or surgical aortic-valve replacement in intermediate-risk patients.N Engl J Med. 2016; 374: 1609-1620
- Transcatheter aortic-valve replacement with a balloon-expandable valve in low-risk patients.N Engl J Med. 2019; 380: 1695-1705
- Mitral regurgitation in low-flow, low-gradient aortic stenosis patients undergoing TAVR.JACC Cardiovasc Interv. 2020; 13: 567-579
- 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
- Clinical impact and evolution of mitral regurgitation following transcatheter aortic valve replacement: a meta-analysis.Heart. 2015; 101: 1395-1405
- Transcatheter aortic valve replacement: outcomes of patients with moderate or severe mitral regurgitation.J Am Coll Cardiol. 2012; 59: 2068-2074
- Meta-analysis of the impact of mitral regurgitation on outcomes after transcatheter aortic valve implantation.Am J Cardiol. 2015; 115: 942-949
- 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
- Impact of preoperative mitral valve regurgitation on outcomes after transcatheter aortic valve implantation.Eur J Cardiothorac Surg. 2012; 41: 1271-1276
- 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
- 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
- Transcatheter aortic valve implantation in patients with concomitant mitral and tricuspid regurgitation.Ann Thorac Surg. 2013; 95: 77-84
- Outcomes of transcatheter aortic valve replacement in patients with mitral valve regurgitation.Postepy Kardiol Interwencyjnej. 2019; 15: 187-194
- 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
- Impact of TAVI on mitral regurgitation: A prospective echocardiographic study.Echocardiography. 2013; 30: 250-257
Article Info
Publication History
Published online: June 19, 2022
Received in revised form:
April 21,
2022
Received:
December 12,
2021
Footnotes
Funding: None.
Identification
Copyright
© 2022 Elsevier Inc. All rights reserved.
