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Clinical impact of post procedural mitral regurgitation after transcatheter aortic valve replacement.

Abstract：

BACKGROUND:While the impact of mitral regurgitation (MR) prior to transcatheter aortic valve replacement (TAVR) has been intensively studied, the implications of post-procedural MR on outcome are unknown. We investigated the clinical and physiological impact of significant MR after TAVR. METHODS:Clinical and echocardiographic data of 486 patients who underwent TAVR between March 2009 and December 2014 were evaluated. Clinical endpoints included overall mortality and combined endpoint of mortality, heart failure re-hospitalization and new atrial fibrillation. Echocardiographic parameters were analyzed at baseline, 30-day and 6-month after TAVR. RESULTS:MR severity improved in 25%, worsened in 19% and did not change in 56% of patients 30-days post TAVR (p = 0.3). Post TAVR MR grade ≥ moderate was present in 16.1%. Predictive accuracy of post TAVR MR was low (AUC = 0.63). Median follow-up was 4.3 years (interquartile range, 2.5 to 6.1). Post TAVR MR grade ≥ moderate was associated with increased mortality and combined cardiac events (p = 0.013 and p < 0.001) even when adjusted for all clinical and echo parameters and when analyzed with propensity score matching. In patients with MR ≥ moderate, LV filling pressure and RV hemodynamics worsened 6 months post TAVR, while improving in patients with less significant post procedural MR. CONCLUSION:Post procedural, but not pre-procedural MR grade ≥ moderate was independently associated with mortality and adverse cardiac events after TAVR. Significant MR post TAVR resulted in adverse LV and RV remodeling and poor hemodynamic. Our study strengthens the rational for initiating early treatment to reduce post TAVR MR.

journal_name

Int J Cardiol

journal_title

International journal of cardiology

authors

Ben-Assa E,Biner S,Banai S,Arbel Y,Laufer-Perl M,Kramarz J,Elmariah S,Inglessis I,Keren G,Finkelstein A,Topilsky Y

doi

10.1016/j.ijcard.2019.07.092

subject

Has Abstract

pub_date

2020-01-15 00:00:00

pages

215-221

eissn

0167-5273

issn

1874-1754

pii

S0167-5273(19)30733-8

journal_volume

299

pub_type

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Clinical impact of post procedural mitral regurgitation after transcatheter aortic valve replacement.