Clinical impact and evolution of mitral regurgitation following transcatheter aortic valve replacement: a meta-analysis

Abstract

Concomitant moderate-severe MR was associated with increased early and late mortality following TAVR. A significant improvement in MR severity was detected in half of the patients following TAVR, and the degree of improvement was greater in those patients who had received a BEV.

Five-year follow-up after transcatheter aortic valve implantation for symptomatic aortic stenosis

“…However, it is unclear whether concomitant mitral regurgitation contributes by itself to the worse outcome or if it is a simple bystander, only indicating an advanced illness. Furthermore, particularly functional mitral regurgitation can behave very differently after TAVI, disappearing in almost one third of cases 31. Therefore, the impact of this finding on patient selection should be further evaluated.…”

2017 AHA/ACC Focused Update of the 2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines

“…In a propensity score-matched comparison of SAPIEN 3 TAVR patients and PARTNER 2A surgical AVR patients, TAVR was both noninferior and superior to surgical AVR (propensity score pooled weighted proportion difference: -9.2%; 95% CI: -13.0 to -5.4; P<0.0001). 63,66 When the choice of surgical AVR or TAVR is being made in an individual patient at intermediate surgical risk, other factors, such as vascular access, comorbid cardiac and noncardiac conditions that affect risk of either approach, expected functional status and survival after AVR, and patient values and preferences, must be considered. The choice of mechanical or bioprosthetic surgical AVR (Section 11 of this focused update) versus a TAVR is an important consideration and is influenced by durability considerations, because durability of transcatheter valves beyond 3 and 4 years is not yet known.…”

“…Disabling stroke occurred in 6.2% of patients treated with TAVR and 6.3% of patients treated with surgical AVR. 62 In an observational study of the SAPIEN 3 valve, 63 TAVR was performed in 1077 intermediate-risk patients with severe symptomatic AS, with the transfemoral approach used in 88% of patients. At 1 year, the rate of all-cause death was 7.4%, disabling stroke occurred in 2%, reintervention was required in 1%, and moderate or severe paravalvular aortic regurgitation was seen in 2%.…”

Pathophysiology and management of multivalvular disease

“…In addition to a secondary aetiology, several factors have been associated with an improvement in the magnitude of mitral regurgitation after aortic valve replacement: poor LV ejection fraction and larger LV volumes (indicating a greater potential for reverse remodelling), smaller left atrial size, absence of atrial fibrillation or pulmonary hypertension (consistent with lesser chronic repercussions of mitral regurgitation), and higher preoperative transaortic pressure gradient and lesser postoperative prosthesis–patient mismatch (consistent with a greater postoperative reduction in systolic transmitral gradient) 12, 18 . In addition, the use of the self-expanding valves seems to be associated with less improvement in mitral regurgitation than the balloon expandable valves 74, 75 . This finding could be explained by anatomical or functional interference with mitral leaflet excursion annulus geometry, or by the increased incidence of LV dyssynchrony resulting from left bundle branch block or pacemaker insertion.…”