Consecutive high risk, inoperable patients undergoing TAVR between 2007 and 2011 for AS has echos at baseline and 1 year and were followed for clinical outcomes. MR severity was graded and patients were grouped as having minimal (none-mild) or significant (moderate- severe) MR.
164 patients underwent TAVR, reducing gradients from 47 to 10mHg. LVEF increased from 48% to 52% while pulmonary aretry systolic pressure (PAPS), LVESD and LVEDD were unchanged. Signficant MR patents had a median 1 grade reduction (p<0,0001) in MR at 1 year. Median LVEF increased by 2% (p=0.0412). Median LVESD decreased by 2.3mm±7.5 (p=0.039). Univariate analysis showed no significant predictors of MR reduction in significant MR patients. Functional and organic significant MR decreased after TAVR but only functional MR patients had improved LVEF (6%, p=0.034), PAPS (5.9mmHg, p=0.022) and LVESD (3.8mm, p=0.013). Multivariate analysis showed functional MR to be a predictor of improved LVEF and PAPS. Clinical outcomes at a mean follow-up of 925 days were not different in patients with significant vs minimal MR; however organic MR patients tended to have more events than functional MR patients (p=0.06).
Significant MR patients undergoing TAVR for severe AS improved in LVEF and LVESD, particularly patients with functional MR. Organic MR is marginally predictive of cardiac complications in AS patients.