Transcatheter aortic valve replacement: outcomes of patients with moderate or severe mitral regurgitation

Stefan Toggweiler, Robert H Boone, Josep Rodés-Cabau, Karin H Humphries, May Lee, Luis Nombela-Franco, Rodrigo Bagur, Alexander B Willson, Ronald K Binder, Ronen Gurvitch, Jasmine Grewal, Robert Moss, Brad Munt, Christopher R Thompson, Melanie Freeman, Jian Ye, Anson Cheung, Eric Dumont, David A Wood, John G Webb
Journal of the American College of Cardiology 2012 June 5, 59 (23): 2068-74

OBJECTIVES: The aim of this study was to evaluate the impact of mitral regurgitation (MR) on outcomes after transcatheter aortic valve replacement (TAVR) and the impact of TAVR on MR.

BACKGROUND: Little is known of the influence of MR on outcomes after TAVR.

METHODS: The outcomes of patients with mild or less (n = 319), moderate (n = 89), and severe (n = 43) MR were evaluated after TAVR at 2 Canadian centers.

RESULTS: Patients with moderate or severe MR had a higher mortality rate than those with mild or less MR during the 30 days after TAVR (adjusted hazard ratio: 2.10; 95% confidence interval: 1.12 to 3.94; p = 0.02). However, the mortality rates after 30 days were similar (adjusted hazard ratio: 0.82; 95% confidence interval: 0.50 to 1.34; p = 0.42). One year after TAVR, moderate MR had improved in 58%, remained moderate in 17%, and worsened to severe in 1%, and 24% of patients had died. Severe MR had improved in 49% and remained severe in 16%, and 35% of patients had died. Multivariate predictors of improved MR at 1 year (vs. unchanged MR, worse MR, or death) were a mean transaortic gradient ≥ 40 mm Hg, functional (as opposed to structural) MR, the absence of pulmonary hypertension, and the absence of atrial fibrillation.

CONCLUSIONS: Moderate or severe MR in patients undergoing TAVR is associated with a higher early, but not late, mortality rate. At 1-year follow-up, MR was improved in 55% of patients with moderate or severe MR at baseline. Improvement was more likely in patients with high transaortic gradients, with functional MR, without pulmonary hypertension and without atrial fibrillation.

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