Courtesy of Dr. Carlos Fava.

Transcatheter aortic valve replacement (TAVR) has been proven to reduce mortality and improve the quality of life of patients with pure severe aortic stenosis (PAS). However, there is a significant number of patients who experience mixed aortic stenosis associated with moderate/severe aortic regurgitation (MAS). These subjects were excluded from the PARTNER and SURTAVI trials, which limits the already scarce knowledge that we have on their evolution and whatever benefits they obtain from TAVR.

This study analyzed 793 consecutive patients, among whom 106 experienced MAS (13.4%).

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MAS patients were younger and at higher surgical risk, had more severe heart failure, lower gradient, and greater ventricular diameter. Furthermore, the presence of coronary disease, acute myocardial infarction, and myocardial revascularization surgery was higher among this group.

After implantation, the rate of moderate/severe aortic regurgitation was higher for the MAS arm (15.7% vs. 3.6%; p = 0.003), even after propensity-score and multivariable adjustments.

No difference was observed in 30-day events, except for lower ejection fraction in patients with MAS.

Read also: “Peripheral Vascular Disease Is Associated to More Events in TAVR”.

All-cause mortality, cardiac mortality, and functional class improvement was similar for both patient groups.

Conclusion

A significant proportion of patients referred for TAVR in the real world have MAS. The clinical evolution of these patients is ultimately comparable to that of subjects with PAS when it comes to the short and medium term, despite higher risks. In that sense, MAS should not be considered a contraindication for TAVR.

Editorial Comment

The presence of MAS is quite frequent in the real world and it has not been associated with worse outcomes in this study. While this patient group presented higher rates of moderate to severe leak, this was not associated with a negative impact. This may possibly be due to prior adaptation of the left ventricle.

More data and a longer follow-up period are necessary to ascertain whether MAS is related to more events or valve implication.

Courtesy of Dr. Carlos Fava.

Original title: Transcatheter Aortic Valve Implantation for Mixed Versus Pure Stenotic Aortic Valve Disease.

Reference: Mohammad Abdelghani.  EuroIntervention 2017;13:1157-1165.

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