Transcatheter Aortic Valve Replacement
Open accessAbstract
Objectives The aim of this study was to evaluate the impact of mitral regurgitation (MR) on outcomes after transcatheter aortic valve replacement (TAVR) and the impact of TAVR on MR.Background Little is known of the influence of MR on outcomes after TAVR.Methods The outcomes of patients with mild or less (n = 319), moderate (n = 89), and severe (n = 43) MR were evaluated after TAVR at 2 Canadian centers.Results Patients with moderate or severe MR had a higher mortality rate than those with mild or less MR during the 30 days after TAVR (adjusted hazard ratio: 2.10; 95% confidence interval: 1.12 to 3.94; p = 0.02). However, the mortality rates after 30 days were similar (adjusted hazard ratio: 0.82; 95% confidence interval: 0.50 to 1.34; p = 0.42). One year after TAVR, moderate MR had improved in 58%, remained moderate in 17%, and worsened to severe in 1%, and 24% of patients had died. Severe MR had improved in 49% and remained severe in 16%, and 35% of patients had died. Multivariate predictors of improved MR at 1 year (vs. unchanged MR, worse MR, or death) were a mean transaortic gradient ≥ 40 mm Hg, functional (as opposed to structural) MR, the absence of pulmonary hypertension, and the absence of atrial fibrillation.Conclusions Moderate or severe MR in patients undergoing TAVR is associated with a higher early, but not late, mortality rate. At 1-year follow-up, MR was improved in 55% of patients with moderate or severe MR at baseline. Improvement was more likely in patients with high transaortic gradients, with functional MR, without pulmonary hypertension and without atrial fibrillation.
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In patients with considerable associated mitral or tricuspid regurgitation, it is unclear whether concomitant surgical repair at the time of aortic valve replacement improves clinical outcomes.
“In patients with considerable associated mitral or tricuspid regurgitation, it is unclear whether concomitant surgical repair of the mitral or tricuspid valve at the time of AVR would improve clinical outcomes242;243.”
From Calcific aortic stenosis (2016) · cites this paper as [242]
The Survival section (p. 2073) reports increased postoperative morbidity and mortality with combined mitral and aortic valve surgery, and conflicting findings about the effects of leaving moderate mitral regurgitation untreated during surgical aortic valve replacement. This supports uncertainty about the clinical benefit of concomitant mitral repair, but the paper does not address concomitant tricuspid repair. (LLM, conf=0.82)
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- Authors
- Toggweiler, S., Boone, R. H., Rodés-Cabau, J., Humphries, K. H., Lee, M., Nombela-Franco, L., Bagur, R., Willson, A. B., Binder, R. K., Gurvitch, R., Grewal, J., Moss, R., Munt, B., Thompson, C. R., Freeman, M., Ye, J., Cheung, A., Dumont, E., Wood, D. A., & Webb, J. G.
- Affiliations
- University of British Columbia (CA)
- Institut universitaire de cardiologie et de pneumologie de Québec (CA)
- Corresponding author
- Webb, John G.
- ORCID
- Venue
- Journal of the American College of Cardiology
- Publisher
- Elsevier BV
- Published
- 2012-06
- Volume
- 59
- Issue
- 23
- Pages
- 2068-2074
- ISSN
- 0735-1097 (ISSN-L)
- OpenAlex
- W195680333
- Cited by
- 215
- References
- 35
- Citations by year
- 2026: 1 · 2025: 11 · 2024: 17 · 2023: 11 · 2022: 15 · 2021: 16 · 2020: 15 · 2019: 19 · 2018: 13 · 2017: 14 · 2016: 19 · 2015: 15 · 2014: 19 · 2013: 25 · 2012: 5
- FWCI
- 13.17
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Journal of the American College of Cardiology (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Swiss National Foundation
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Valve Diseases and Treatments
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Aortic Disease and Treatment Approaches
- Health Sciences › Medicine › Epidemiology › Infective Endocarditis Diagnosis and Management
- Keywords
- transcatheter aortic valve implantation, mitral regurgitation, aortic valve gradient, functional mitral regurgitation, pulmonary hypertension, atrial fibrillation, prognostic factors
- MeSH terms
- Aged, Aged, 80 and over, Aortic Valve Stenosis, Bioprosthesis, British Columbia, Female, Follow-Up Studies, Cardiac Catheterization, Heart Valve Prosthesis, Humans, Male, Mitral Valve Insufficiency, Predictive Value of Tests, Prosthesis Failure, Retrospective Studies, Severity of Illness Index, Time Factors, Echocardiography, Doppler, Cohort Studies, Proportional Hazards Models, Odds Ratio, Survival Analysis, Treatment Outcome, Risk Assessment, Statistics, Nonparametric, Minimally Invasive Surgical Procedures, Heart Valve Prosthesis Implantation, Kaplan-Meier Estimate
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