Courtesy of Dr. Carlos Fava.
This study sought to analyze the clinical impact and the level of improvement of mitral regurgitation (MR) in patients who receive a transcatheter aortic valve replacement (TAVR), and to find potential candidates for double valve repair with percutaneous techniques.
Of 1.110 patients included, 177 (15.9%) suffered from severe pre-TAVR mitral regurgitation.
Mean population age was 80.5 years old; the ejection fraction and pulmonary systolic pressure were similar between the two groups involved. However, the gradient and the valve area indexed were lower among those who presented mitral regurgitation.
Additionally, those with MR presented a larger mitral annular diameter (34.5±4 mm versus 32.7±4.8 mm p = 0.0001), further annular calcification and tenting parameters. The most common cause for mitral regurgitation was functional.
The success of the procedure was similar for both groups, but those who presented mitral regurgitation required hemodynamic support.
Upon comparison, patients who suffered from pre-TAVR mitral regurgitation presented a 3-fold increase in mortality and cardiac mortality versus those without pre-TAVR MR, both during their hospitalization (10,2% versus 35%; p < 0.001) and at 6 months (6% versus 20,9% p < 0.001).
After the TAVR, 103 (58.3%) patients with mitral regurgitation showed at least a 1-point improvement in MR.
A mitral annular diameter of >35.5 mm and annular calcification by tomography were predictors of persistent MR. At least 14 patients met the criteria for mitral repair with either MitraClip or a balloon-expandable valve.
Conclusion
The presence of mitral regurgitation is relatively common in TAVR recipients and is associated with higher mortality. In over 50% of patients, the degree of MR improves after TAVR, which can be predicted through a computed tomography scan of the mitral valve.
According to current standards, at least 1 in 10 patients with persistent MR after TAVR could benefit from percutaneous mitral procedures.
Comentario editorial
The association between aortic stenosis and mitral regurgitation was usually low in the analyzed series; however, it will probably increase alongside life expectancy.
With further technological development and experience gained by different heart teams, our strategies will probably change and both valves will be treated with percutaneous strategies, whether simultaneously or not.
Original title: Mitral Regurgitation After Transcatheter Aortic Valve Replacement. Prognosis, Imaging Predictors and Potential Management.
Reference: Carlos Cortés, et al. J Am Coll Cardiol Intv 2016;9:1603-14.
Courtesy of Dr. Carlos Fava. Buenos Aires Favaloro Foundation, Argentina.
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