TY - JOUR
T1 - Effect of Transcatheter Aortic Valve Replacement on Concomitant Mitral Regurgitation and Its Impact on Mortality
AU - Witberg, Guy
AU - Codner, Pablo
AU - Landes, Uri
AU - Schwartzenberg, Shmuel
AU - Barbanti, Marco
AU - Valvo, Roberto
AU - De Backer, Ole
AU - Ooms, Joris F.
AU - Islas, Fabian
AU - Marroquin, Luis
AU - Sedaghat, Alexander
AU - Sugiura, Atsushi
AU - Masiero, Giulia
AU - Werner, Paul
AU - Armario, Xavier
AU - Fiorina, Claudia
AU - Arzamendi, Dabit
AU - Santos-Martinez, Sandra
AU - Fernández-Vázquez, Felipe
AU - Baz, Jose A.
AU - Steblovnik, Klemen
AU - Mauri, Victor
AU - Adam, Matti
AU - Merdler, Ilan
AU - Hein, Manuel
AU - Ruile, Philipp
AU - Grasso, Carmelo
AU - Branca, Luca
AU - Estévez-Loureiro, Rodrigo
AU - Benito-González, Tomás
AU - Amat-Santos, Ignacio J.
AU - Mylotte, Darren
AU - Andreas, Martin
AU - Bunc, Matjaz
AU - Tarantini, Giuseppe
AU - Sinning, Jan Malte
AU - Nombela-Franco, Luis
AU - Søndergaard, Lars
AU - Van Mieghem, Nicolas M.
AU - Finkelstein, Ariel
AU - Kornowski, Ran
N1 - Publisher Copyright:
© 2021 American College of Cardiology Foundation
PY - 2021/6/14
Y1 - 2021/6/14
N2 - 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).
AB - 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).
KW - TAVR
KW - TMVR/r
KW - aortic stenosis
KW - mitral regurgitation
UR - http://www.scopus.com/inward/record.url?scp=85106907405&partnerID=8YFLogxK
U2 - 10.1016/j.jcin.2021.02.030
DO - 10.1016/j.jcin.2021.02.030
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C2 - 33992550
AN - SCOPUS:85106907405
SN - 1936-8798
VL - 14
SP - 1181
EP - 1192
JO - JACC: Cardiovascular Interventions
JF - JACC: Cardiovascular Interventions
IS - 11
ER -