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Degenerative mitral regurgitation predicts worse outcomes in patients undergoing transcatheter aortic valve replacement
Author(s) -
Kindya Bryan,
Ouzan Elisha,
Lerakis Stamatios,
Gonen Erhan,
Babaliaros Vasilis,
Karayel Eren,
Thourani Vinod H.,
Gotsman Israel,
Devireddy Chandan M.,
Danenberg Haim D.,
Leshnower Bradley G.,
Beeri Ronen,
Ko YiAn,
Gilon Dan,
Ahmed Hina,
Liu Chang,
Lotan Chaim,
Mavromatis Kreton
Publication year - 2018
Publication title -
catheterization and cardiovascular interventions
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.988
H-Index - 116
eISSN - 1522-726X
pISSN - 1522-1946
DOI - 10.1002/ccd.27607
Subject(s) - medicine , mitral regurgitation , valve replacement , etiology , heart failure , cardiology , surgery , stenosis
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.