Impact of baseline mitral regurgitation on short- and long-term outcomes following transcatheter aortic valve replacement

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• 作者：Sarkis Kiramijyan ; MD ; Marco A. Magalhaes ; MD ; Edward Koifman ; MD ; Romain Didier ; MD ; Ricardo O. Escarcega ; MD ; Sa&rsquo ; ar Minha ; MD ; Nevin C. Baker ; DO ; Smita I. Negi ; MD ; Rebecca Torguson ; MPH ; Jiaxiang Gai ; MSPH ; Petros Okubagzi ; MD ; Federico M. Asch ; MD ; Michael A. Gaglia Jr. ; MD ; Itsik Ben-Dor ; MD ; Lowell F. Satler ; MD ; Augusto D. Pichard ; MD ; Ron Waksman ; MD ; ^{ron.waksman@medstar.net" class="auth_mail" title="E-mail the corresponding author}
• 刊名：American Heart Journal
• 出版年：2016
• 出版时间：August 2016
• 年：2016
• 卷：178
• 期：Complete
• 页码：19-27
• 全文大小：587 K

文摘

The prevalence of concomitant significant mitral regurgitation (MR) in patients with severe aortic stenosis (AS) undergoing transcatheter aortic valve replacement (TAVR) ranges from 2% to 33%. The impact of significant MR on post-TAVR outcomes remains controversial.

Methods

The data from a cohort of patients with symptomatic severe AS undergoing TAVR at out institution were retrospectively analyzed. The last transthoracic echocardiogram (TTE) before the index TAVR procedure was selected as the baseline assessment of the degree of MR. The total study cohort (N = 589) was divided into 2 groups: significant ≥moderate MR (n = 68) versus nonsignificant <moderate MR (n = 521) at baseline. The 2 groups were compared in regard to baseline, imaging, procedural, and postprocedural characteristics. In-hospital, 30-day, and 1-year outcomes were assessed. Multivariate Cox regression survival analyses were performed to test the independent effect of ≥moderate MR on mortality at short- and long-term follow-up periods.

Results

Patients with ≥moderate MR had a higher mortality rate versus patients with <moderate MR during the initial 30-day follow-up after TAVR (unadjusted log-rank P = .011, risk-adjusted P = .031, hazard ratio = 2.40, 95% CI 1.08-5.29). However, the mortality rates at 1-year follow-up postprocedure were similar between the 2 groups (unadjusted log-rank P = .553, risk-adjusted P = .331, hazard ratio = 0.70, 95% CI 0.35-1.43). Among the original ≥moderate group, 62.5% and 77.7% of patients had improved to <moderate MR at 30-day and 1-year follow-up, respectively.

Conclusions

Moderate or greater MR in patients undergoing TAVR is associated with a higher 30-day but not 1-year mortality. A majority of the patients demonstrated significant improvement in MR following TAVR.