Impact of Baseline Mitral Regurgitation on Short- and Long-Term Outcomes Following Transcatheter Aortic Valve Replacement

• Published in: The American heart journal Vol. 178; pp. 19 - 27
• Main Authors: Kiramijyan, Sarkis, MD, Magalhaes, Marco A., MD, Koifman, Edward, MD, Didier, Romain, MD, Escarcega, Ricardo O., MD, Minha, Sa’ar, MD, Baker, Nevin C., DO, Negi, Smita I., MD, Torguson, Rebecca, MPH, Gai, Jiaxiang, MSPH, Okubagzi, Petros, MD, Asch, Federico M., MD, Gaglia, Michael A., MD, Ben-Dor, Itsik, MD, Satler, Lowell F., MD, Pichard, Augusto D., MD, Waksman, Ron, MD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-08-2016; Elsevier Limited
• Subjects: Aged; Aged, 80 and over; Anesthesia; Aortic Valve Stenosis - diagnostic imaging; Aortic Valve Stenosis - epidemiology; Aortic Valve Stenosis - surgery; Cardiology; Cardiovascular; Cohort Studies; Comorbidity; Databases, Factual; Echocardiography; Female; Hospitals; Humans; Intubation; Laboratories; Male; Medical imaging; Medical personnel; Mitral Valve Insufficiency - diagnostic imaging; Mitral Valve Insufficiency - epidemiology; Mortality; Patient safety; Prognosis; Proportional Hazards Models; Retrospective Studies; Severity of Illness Index; Studies; Survival Analysis; Transcatheter Aortic Valve Replacement; Treatment Outcome; Variables
• ISSN: 0002-8703; 1097-6744
• DOI: 10.1016/j.ahj.2016.03.020

Abstract Background The prevalence of concomitant significant mitral regurgitation (MR) in patients with severe aortic stenosis undergoing transcatheter aortic valve replacement (TAVR) ranges from 2 to 33%. The impact of significant MR on post TAVR outcomes remains controversial. Methods The data from a cohort of patients with symptomatic severe aortic stenosis (AS) undergoing TAVR at out institution were retrospectively analyzed. The last trans-thoracic echocardiogram (TTE) prior to the index TAVR procedure was selected as the baseline assessment of the degree of MR. The total study cohort (N=589) was divided into 2 groups: significant ≥Moderate MR (n=68) vs. non-significant <moderate MR (n=521) at baseline. The 2 groups were compared in regard to baseline, imaging, procedural, and post-procedural characteristics. In-hospital, 30-days and 1-year outcomes were assessed. Multivariate Cox regression survival analyses were performed to test the independent effect of ≥moderate MR on mortality at short- and long-term follow-up periods. Results Patients with ≥moderate MR had a higher mortality rate vs. patients with <moderate MR during the initial 30-days follow-up after TAVR (unadjusted log-rank p=0.011, risk-adjusted p=0.031, HR=2.40, 95% CI: 1.08-5.29). However, the mortality rates at 1-year follow-up post-procedure were similar between the 2 groups (unadjusted log-rank p=0.553, risk-adjusted p=0.331, HR=0.70, 95% confidence interval: 0.35-1.43). Among the original ≥moderate group, 62.5% and 77.7% of patients had improved to <moderate MR at 30-days and 1-year follow-up, respectively. Conclusions Moderate or greater MR in patients undergoing TAVR is associated with a higher 30-day but not 1-year mortality. A majority of the patients demonstrated significant improvement in MR following TAVR.