Author + information
- Giorgio Medranda1
Mitral regurgitation (MR) frequently accompanies symptomatic severe aortic stenosis (AS) and contributes to mortality. Traditionally, in patients who undergo surgical aortic valve replacement (SAVR), pre-SAVR MR results in concomitant surgical replacement/repair. For those who undergo transcatheter aortic valve replacement (TAVR), MR is often left untreated. Changes in untreated MR following TAVR remain unclear.
In a retrospective observational study from 2012-2016, we reviewed data from 709 patients who underwent TAVR at our institution. We reviewed AS and MR on transthoracic echocardiogram (TTE). Statistical analysis of outcomes were performed using paired t-test (aortic valve (AV) area, peak velocity, mean gradient), Wilcoxon Signed Rank test (MR grade) and Spearman’s Rank correlation.
The 709 patients had a mean age of 82.7±8.26 years, were 96.46% non-Hispanic Caucasian and were 47.11% male. Of these patients, 595 were found to have pre-existing MR (mild/1+, moderate/2+, moderate-severe/3+ or severe/4+) and of those, 69 patients were found to have had pre-existing clinically significant MR (3+/4+). In those with pre-existing MR, there was a significant improvement in MR post-TAVR (2+ to 1+, p<0.001). In those with pre-existing clinically significant MR, there was an even stronger improvement in MR post-TAVR (4+ to 2+, p<0.001). In these patients, there was a significant improvement in AV peak velocity (4.11m/s vs 2.09m/s, p<0.001), AV area (0.62cm2 vs 1.77cm2, p<0.001) and AV mean gradient post-TAVR (43.44mmHg vs 11.38mmHg, p<0.001). In particular the AV area was found to significantly correlate with degree of improvement in MR grade (p=0.006).
In patients with severe AS and moderate-severe/severe MR, treatment with TAVR improved MR grade in 82.61% of patients (P<0.001). Furthermore, there was a strong trend for greater MR grade improvement in patients who displayed greater improvements of AV area following TAVR (p=0.006). A staged approach, with percutaneous mitral valve repair, may be required for patients with severe AS and significant MR who fail to improve following TAVR.
STRUCTURAL: Valvular Disease: Mitral