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Change in mitral regurgitation severity impacts survival after transcatheter aortic valve replacement

Journal article
Authors K. Feldt
R. De Palma
H. Bjursten
Petur Petursson
N. E. Nielsen
T. Kellerth
A. Jonsson
J. Nilsson
A. Ruck
M. Settergren
Published in International Journal of Cardiology
Volume 294
Pages 32-36
ISSN 0167-5273
Publication year 2019
Published at Institute of Medicine, Department of Molecular and Clinical Medicine
Pages 32-36
Language en
Links dx.doi.org/10.1016/j.ijcard.2019.07...
Keywords TAVR, Mitral regurgitation, Survival, Prognosis, Long-term, native valvular regurgitation, corevalve revalving system, late, outcomes, implantation, recommendations, predictors, metaanalysis, mortality, evolution, tavi, Cardiovascular System & Cardiology
Subject categories Cardiac and Cardiovascular Systems

Abstract

Background: The impact of a change in mitral regurgitation (MR) following TAVR is unknown. We studied the impact of baseline MR and early post-procedural change in MR on survival following TAVR. Methods: The SWEDEHEART registry included all TAVRs performed in Sweden. Patients were dichotomized into no/mild and moderate/severe MR groups. Vital status, echocardiographic data at baseline and within 7 days after TAVR were analyzed. Results: 1712 patients were included. 1404 (82%) had no/mild MR and 308 (18%) had moderate/severe MR. Baseline moderate/severe MR conferred a higher mortality rate at 5-year follow-up (adjusted HR 1.29, CI 1.01-1.65, p = 0.04). Using persistent <= mild MR as the reference, when moderate/severe MR persisted or if MR worsened from <= mild at baseline to moderate/severe after TAVR, higher 5-year mortality rates were seen (adjusted HR 1.66, CI 1.17-2.34, p = 0.04; adjusted HR 1.97, CI 1.29-3.00, p = 0.002, respectively). If baseline moderate/severe MR improved to = mild after TAVR no excess mortality was seen (HR 1.09, CI 0.75-1.58, p = 0.67). Paravalvular aortic regurgitation (PVL) was inversely associated with MR improvement after TAVR (OR 0.4, 95%: CI 0.17-0.94; p = 0.034). Atrial fibrillation (OR 2.1, 95% CI: 1.27-3.39, p = 0.004), self-expanding valve (OR 3.8, 95% CI: 2.08-7.14, p < 0.0001), and PVL (4.3, 95% CI 2.32-7.78. p < 0.0001) were associated with MR worsening. Conclusions: Moderate/severe baseline MR in patients undergoing TAVR is associated with a mortality increase during 5 years of follow-up. This risk is offset if MR improves to <= mild, whereas worsening of MR after TAVR is associated with a 2-fold mortality increase.

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