Effect of Transcatheter Aortic Valve Replacement on Concomitant Mitral Regurgitation and Its Impact on Mortality

Guy Witberg, Pablo Codner, Uri Landes, Shmuel Schwartzenberg, Marco Barbanti, Roberto Valvo, Ole De Backer, Joris F. Ooms, Fabian Islas, Luis Marroquin, Alexander Sedaghat, Atsushi Sugiura, Giulia Masiero, Paul Werner, Xavier Armario, Claudia Fiorina, Dabit Arzamendi, Sandra Santos-Martinez, Felipe Fernández-Vázquez, Jose A. BazKlemen Steblovnik, Victor Mauri, Matti Adam, Ilan Merdler, Manuel Hein, Philipp Ruile, Carmelo Grasso, Luca Branca, Rodrigo Estévez-Loureiro, Tomás Benito-González, Ignacio J. Amat-Santos, Darren Mylotte, Martin Andreas, Matjaz Bunc, Giuseppe Tarantini, Jan Malte Sinning, Luis Nombela-Franco, Lars Søndergaard, Nicolas M. Van Mieghem, Ariel Finkelstein, Ran Kornowski

Research output: Contribution to journalArticlepeer-review


Objectives: The purpose of this study was to examine the impact of residual mitral regurgitation (MR) on mortality in patients undergoing transcatheter aortic valve replacement (TAVR). Background: MR is common in patients undergoing TAVR. Data on optimal management of patients with significant MR after TAVR are limited. Methods: The registry consisted of 16 TAVR centers (n = 7,303). Outcomes of patients with ≥ moderate versus lesser grade MR after TAVR were compared. Results: In 1,983 (27.2%) patients, baseline MR grade was ≥ moderate. MR regressed in 874 (44.1%) patients and persisted in 1,109 (55.9%) after TAVR. Four-year mortality was higher for those with MR persistence, but not for those with MR regression after TAVR, compared with nonsignificant baseline MR (43.8% vs. 35.1% vs. 32.4%; hazard ratio [HR]: 1.38; p = 0.008; HR: 1.02; p = 0.383, respectively). New York Heart Association functional class III to IV after TAVR was more common in those with MR persistence vs. regression (14.4% vs. 3.9%; p < 0.001). In a propensity score–matched cohort (91 patients’ pairs), with significant residual MR after TAVR who did or did not undergo staged mitral intervention, staged intervention was associated with a better functional class through 1 year of follow-up (82.4% vs. 33.3% New York Heart Association functional class I or II; p < 0.001), and a numerically lower 4-year mortality, which was not statistically significant (64.6% vs. 37.5%; HR: 1.66; p = 0.097). Conclusions: Risk stratification based on improvement in MR and symptoms after TAVR can identify patients at increased mortality risk after TAVR. These patients may benefit from a staged transcatheter mitral intervention, but this requires further proof from future studies. (Transcatheter Treatment for Combined Aortic and Mitral Valve Disease. The Aortic+Mitral TRAnsCatheter [AMTRAC] Valve Registry [AMTRAC]; NCT04031274).

Original languageEnglish
Pages (from-to)1181-1192
Number of pages12
JournalJACC: Cardiovascular Interventions
Issue number11
StatePublished - 14 Jun 2021


  • TAVR
  • TMVR/r
  • aortic stenosis
  • mitral regurgitation


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