Degenerative mitral regurgitation predicts worse outcomes in patients undergoing transcatheter aortic valve replacement

Bryan Kindya, Elisha Ouzan, Stamatios Lerakis, Erhan Gonen, Vasilis Babaliaros, Eren Karayel, Vinod H. Thourani, Israel Gotsman, Chandan M. Devireddy, Haim D. Danenberg, Bradley G. Leshnower, Ronen Beeri, Yi An Ko, Dan Gilon, Hina Ahmed, Chang Liu, Chaim Lotan, Kreton Mavromatis

Research output: Contribution to journalArticlepeer-review

5 Scopus citations

Abstract

Objectives: To evaluate the role mitral regurgitation (MR) etiology and severity play in outcomes for patients undergoing transcatheter aortic valve replacement (TAVR). Background: Multiple prior studies have investigated the influence of MR severity on outcomes for patients undergoing TAVR. Less has been published regarding the effects of MR etiology on outcomes, including its impact on heart failure hospitalization. Methods: Two hundred and seventy patients undergoing TAVR at 2 hospitals were enrolled. Each patient had a baseline and follow-up (within 30 days of TAVR) echocardiogram that was analyzed. MR was graded as none, mild, moderate, or severe, as well as functional or degenerative. We compared patient outcomes, including death and heart failure hospitalization, among none-mild MR, moderate-severe functional MR, and moderate-severe degenerative MR groups. Results: Two hundred and seventy patients underwent TAVR, reducing mean aortic valve gradients from 45 ± 15 mm Hg to 9 ± 4 mm Hg. On multivariable analysis, only patients with moderate-severe degenerative MR had decreased survival free of death or CHF hospitalization compared to those with none-mild MR (P =.011). Subanalysis showed patients with moderate-severe degenerative MR were more likely to be hospitalized for heart failure at 2 years compared to those with moderate-severe functional MR (P =.02). Patients with moderate-severe degenerative MR were also less likely to have improvement in MR severity at follow up (P =.01). Conclusions: Special consideration should be given to patients with moderate-severe degenerative MR undergoing TAVR. As transcatheter approaches for mitral valve repair and replacement continue to evolve, moderate-severe degenerative MR patients may benefit from consideration of double valve intervention.

Original languageEnglish
Pages (from-to)574-582
Number of pages9
JournalCatheterization and Cardiovascular Interventions
Volume92
Issue number3
DOIs
StatePublished - 1 Sep 2018
Externally publishedYes

Keywords

  • aortic stenosis
  • heart failure
  • mitral regurgitation
  • transcatheter aortic valve replacement

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