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

Artikel i vetenskaplig tidskrift
Författare K. Feldt
R. De Palma
H. Bjursten
Petur Petursson
N. E. Nielsen
T. Kellerth
A. Jonsson
J. Nilsson
A. Ruck
M. Settergren
Publicerad i International Journal of Cardiology
Volym 294
Sidor 32-36
ISSN 0167-5273
Publiceringsår 2019
Publicerad vid Institutionen för medicin, avdelningen för molekylär och klinisk medicin
Sidor 32-36
Språk en
Länkar dx.doi.org/10.1016/j.ijcard.2019.07...
Ämnesord 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
Ämneskategorier Kardiologi

Sammanfattning

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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