Effect of Transcatheter Aortic Valve Replacement on Concomitant Mitral Regurgitation and Its Impact on Mortality |
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Authors: | 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 Ran Kornowski |
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Affiliation: | 1. Department of Cardiology, Rabin Medical Center, Petach Tikva, Israel;2. Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel;3. Division of Cardiology, University of Catania, Catania, Italy;4. The Heart Center, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark;5. Department of Cardiology, Thoraxcenter, Erasmus University Medical Center, Rotterdam, the Netherlands;6. Cardiovascular Institute, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria San Carlos, Madrid, Spain;7. Herzzentrum Bonn, Universitätsklinikum Bonn, Bonn, Germany;8. Department of Cardiac, Thoracic and Vascular Sciences, University of Padua Medical School, Padua, Italy;9. Division of Cardiac Surgery, Medical University of Vienna, Vienna, Austria;10. Department of Cardiology, Galway University Hospital, National University of Ireland, Galway, Ireland;11. Cardiovascular Department, Spedali Civili, Brescia, Italy;12. Hospital de Sant Creu i Sant Pau Barcelona, Barcelona, Spain;13. Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares, Hospital Clínico Universitario de Valladolid, Valladolid, Spain;14. Department of Cardiology, University Hospital of León, León, Spain;15. Servicio de Cardiología, Hospital Álvaro Cunqueiro, Vigo, Spain;p. Department of Cardiology, University Medical Centre, Ljubljana, Slovenia;q. Department of Cardiology, Heart Centre, Faculty of Medicine, University of Cologne, Germany;r. Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel;s. Department of Cardiology and Angiology II, University Heart Center Freiburg-Bad Krozingen, Bad Krozingen, Germany |
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Abstract: | ObjectivesThe purpose of this study was to examine the impact of residual mitral regurgitation (MR) on mortality in patients undergoing transcatheter aortic valve replacement (TAVR).BackgroundMR is common in patients undergoing TAVR. Data on optimal management of patients with significant MR after TAVR are limited.MethodsThe registry consisted of 16 TAVR centers (n = 7,303). Outcomes of patients with ≥ moderate versus lesser grade MR after TAVR were compared.ResultsIn 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).ConclusionsRisk 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). |
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Keywords: | aortic stenosis mitral regurgitation TAVR TMVR/r AS" },{" #name" :" keyword" ," $" :{" id" :" kwrd0035" }," $$" :[{" #name" :" text" ," _" :" aortic stenosis CI" },{" #name" :" keyword" ," $" :{" id" :" kwrd0045" }," $$" :[{" #name" :" text" ," _" :" confidence interval HR" },{" #name" :" keyword" ," $" :{" id" :" kwrd0055" }," $$" :[{" #name" :" text" ," _" :" hazard ratio IQR" },{" #name" :" keyword" ," $" :{" id" :" kwrd0065" }," $$" :[{" #name" :" text" ," _" :" interquartile range MR" },{" #name" :" keyword" ," $" :{" id" :" kwrd0075" }," $$" :[{" #name" :" text" ," _" :" mitral regurgitation NYHA" },{" #name" :" keyword" ," $" :{" id" :" kwrd0085" }," $$" :[{" #name" :" text" ," _" :" New York Heart Association PMVR" },{" #name" :" keyword" ," $" :{" id" :" kwrd0095" }," $$" :[{" #name" :" text" ," _" :" percutaneous edge-to-edge mitral valve repair PSM" },{" #name" :" keyword" ," $" :{" id" :" kwrd0105" }," $$" :[{" #name" :" text" ," _" :" propensity score matched/propensity score matching SAVR" },{" #name" :" keyword" ," $" :{" id" :" kwrd0115" }," $$" :[{" #name" :" text" ," _" :" surgical aortic valve replacement TAVR" },{" #name" :" keyword" ," $" :{" id" :" kwrd0125" }," $$" :[{" #name" :" text" ," _" :" transcatheter aortic valve replacement TMVR/r" },{" #name" :" keyword" ," $" :{" id" :" kwrd0135" }," $$" :[{" #name" :" text" ," _" :" transcatheter mitral valve replacement or repair |
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