Author + information
- Eric Roselli,
- Monica Isabella,
- Jeevanantham Rajeswaran,
- Daniel Johnson,
- David Johnson,
- Benico Barzilai and
- Eugene Blackstone
Mitral regurgitation (MR) is left untreated in patients undergoing transcatheter aortic valve replacement (TAVR). Long–term implications of this strategy should be understood before treating lower risk patients. Objectives were to compare characteristics, survival, MR change, and risk factors in patients presenting with severe aortic stenosis (AS) and 3–4+ MR having aortic valve replacement (AVR) alone versus AVR plus mitral procedure (AVR+MVP).
From 1991 to 2010, 1,023 patients with AS and 3–4+ MR had AVR (n=314) or AVR+MVP (n=709). MVP was not done due to clinical insignificance (57%), intraop echo downgrading (34%), or perceived risk (8%). AVR patients were older with smaller valve areas, and AVR+MVP patients had more myxomatous etiology and more recent surgery. 206 were propensity matched on 81 variables. Follow–up is 3.7y with echo in 68%. Parsimonious and saturated models assessed risk factors.
30 day mortality was higher for AVR+MVP (5% AVR vs 8% AVR+MVP, P=.03) and they had more septicemia, renal failure, and longer length of stay. Survival was worse at 10y for AVR (19% vs. 29%, P=.006; curves cross at 4y, Figure). At 4y, MR was 2+ or worse in 63% of AVR and 24% of AVR+MVP (P<.0001).
AVR+MVP has a higher surgical risk than AVR alone in patients with severe AS and 3–4+MR, but the durable treatment for MR may provide an important late survival benefit. More detailed risk analyses will guide treatment selection for TAVR in lower risk patients with multi–valve disease.
West, Room 2010
Sunday, March 10, 2013, 9:00 a.m.–9:15 a.m.
Session Title: Valvular Heart Disease: Year in Review, Functional MR, E–Clip Updates and MR in the Context of AS
Abstract Category: 32. Valvular Heart Disease: Therapy
Presentation Number: 922–7
- 2013 American College of Cardiology Foundation