Effect of Transcatheter Aortic Valve Replacement on Concomitant Mitral Regurgitation and Its Impact on Mortality

Witberg, Guy; Codner, Pablo; Landes, Uri; Schwartzenberg, Shmuel; Barbanti, Marco; Valvo, Roberto; Ooms, Joris F.; Islas, Fabián; Marroquín, Luis; Sedaghat, Alexander; Sugiura, Atsushi; Masiero, Giulia; Werner, Paul; Fiorina, Claudia; Arzamendi, Dabit; Santos‐Martínez, Sandra; Fernández‐Vázquez, Felipe; Baz, José Antonio; Steblovnik, Klemen; Mauri, Victor; Adam, Matti; Merdler, Ilan; Ruile, Philipp; Grasso, Carmelo; Branca, Luca; Estévez‐Loureiro, Rodrigo; Benito‐González, Tomas; Amat‐Santos, Ignacio J.; Mylotte, Darren; Andreas, Martin; Bunc, Matjaž; Tarantini, Giuseppe; Sinning, Jan‐Malte; Nombela‐Franco, Luis; Søndergaard, Lars; Mieghem, Nicolás M. Van; Finkelstein, Ariel; Kornowski, Ran

doi:10.1016/j.jcin.2021.02.030

Cited by 40 publications

(29 citation statements)

References 18 publications

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“…Similarly, a significant paravalvular leak is associated with persistent MR [61]. Notably, prediction models based on these characteristics had poor discrimination abilities for predicting MR regression after AVR [34]. All together, these data suggest that it is currently difficult to estimate MR change in individual patients because there are no randomized trials, and no evidencebased guidelines about whether MR should be addressed during SAVR or TAVR.…”

Section: The Effects Of Valve Replacement For Aortic Stenosis On Mitral Regurgitationmentioning

confidence: 99%

“…Conversely, although MR persistence after TAVR is seen in nearly half of patients with baseline significant MR, only 14.4% of this group remained highly symptomatic one month following TAVR. [34] Therefore, significant concomitant MR in severe AS is typically left untreated [13]. Studies looking at the outcomes of patients with MR that was left untreated at the time of SAVR did not show MR as a predictor of early or late mortality [5].…”

Section: The Consequences Of Untreated Severe Mitral Regurgitation At the Time Of Aortic Valve Replacementmentioning

confidence: 99%

“…Whereas isolated surgical AVR (SAVR) in old patients leads to acceptable mortality rate (approximatively 1-3%), the operative risk is substantially increased when double valve surgery is planned, with or without revascularization [33]. Conversely, although MR persistence after TAVR is seen in nearly half of patients with baseline significant MR, only 14.4% of this group remained highly symptomatic one month following TAVR [34]. Therefore, significant concomitant MR in severe AS is typically left untreated [13].…”

Section: The Consequences Of Untreated Severe Mitral Regurgitation At the Time Of Aortic Valve Replacementmentioning

confidence: 99%

“…This risk is offset if MR improves to ≤mild, whereas the worsening of MR after TAVR is associated with a two-fold mortality increase [53]. Of note, symptoms resolution after TAVR despite MR persistence likely identifies a subset of patients in whom MR plays a more minor role in the overall morbidity burden than AS and is, thus, less likely to impact prognosis post-TAVR [34].…”

Section: The Consequences Of Untreated Severe Mitral Regurgitation At the Time Of Aortic Valve Replacementmentioning

confidence: 99%

“…Therefore, it will be essential to assess the short-and long-term outcomes of this strategy. Recently, the AMTRAC (Aortic+Mitral TRAnsCatheter) valve registry, a large international cohort of patients with significant residual MR after TAVR, found that TMVR/r following TAVR can be performed with a high procedural success rate and is associated with a substantial improvement in MR grade and New York Heart Association (NYHA) functional class after up to 1 year of follow-up [34]. However, randomized controlled trials are required to determine the real benefit of an additional mitral valve procedure compared to optimal medical therapy in patients with severe residual MR after SAVR or TAVR.…”

Section: Decision-making and The Role Of Heart Teammentioning

confidence: 99%

See 4 more Smart Citations

The Common Combination of Aortic Stenosis with Mitral Regurgitation: Diagnostic Insight and Therapeutic Implications in the Modern Era of Advanced Echocardiography and Percutaneous Intervention

Mantovani

Barbieri

Albini

et al. 2021

JCM

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The combination of aortic stenosis (AS) and mitral regurgitation (MR) is common in patients with degenerative valvular disease. It is characterized by having complex pathophysiology, leading to potential diagnostic pitfalls. Evidence is scarce in the literature to direct the diagnostic framework and treatment of patients with this particular combination of multiple valvular diseases. In this complex scenario, the appropriate use of advanced echocardiography and multimodality imaging methods plays a central role. Transcatheter mitral valve replacement or repair and transcatheter aortic valve replacement widen the surgical options for valve diseases. Therefore, there is an increasing need to reconsider the function, timing, and mode intervention for patients with a combination of AS with MR towards more personalized treatment.

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Section: The Effects Of Valve Replacement For Aortic Stenosis On Mitral Regurgitationmentioning

confidence: 99%

Section: The Consequences Of Untreated Severe Mitral Regurgitation At the Time Of Aortic Valve Replacementmentioning

confidence: 99%

Section: The Consequences Of Untreated Severe Mitral Regurgitation At the Time Of Aortic Valve Replacementmentioning

confidence: 99%

Section: The Consequences Of Untreated Severe Mitral Regurgitation At the Time Of Aortic Valve Replacementmentioning

confidence: 99%

Section: Decision-making and The Role Of Heart Teammentioning

confidence: 99%

See 3 more Smart Citations

The Common Combination of Aortic Stenosis with Mitral Regurgitation: Diagnostic Insight and Therapeutic Implications in the Modern Era of Advanced Echocardiography and Percutaneous Intervention

Mantovani

Barbieri

Albini

et al. 2021

JCM

View full text Add to dashboard Cite

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Left ventricular reverse remodeling after transcatheter aortic valve replacement for predominant aortic stenosis and mixed aortic valve disease

Huang,

Lai,

et al. 2023

J of Clinical Ultrasound

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BackgroundMixed aortic valve disease (MAVD) is a frequent concomitant valve disease with unique cardiac pathological changes compared to predominant aortic stenosis (PAS). The previous studies about the MAVD are contradictory. Therefore, a new perspective is needed to assess the value of TAVR for this cohort of patients.MethodsFrom January 2018 to December 2021, 90 MAVD patients and 72 PAS patients who underwent TAVR in our hospital were collected. 1:1 propensity score matching analysis was used to control the bias in patient selection. The dynamic changes in left ventricular morphology and hemodynamics were compared by generalized estimating equations. Univariate or multivariate logistic regression analysis was used to screen for independent risk factors for the non‐occurrence of left ventricular reverse remodeling (non‐LVRR).ResultsAfter the matching procedure, 112 patients were included in the analysis (56 in each group). Baseline characteristics were similar between the two groups. LVRR occurred in both groups, but MAVD had greater left ventricular end‐diastolic volume index and left ventricular mass index, a higher incidence of mitral regurgitation (MR), and a more pronounced transformation of ventricular geometry patterns. Post‐operative MR (odd ratio [OR]: 10.05; 95% confidence interval [CI]: 2.08–48.57; p < .001) and coronary artery disease (OR: 2.82; 95% CI: 1.08–7.34; p = .034) were independent risk factors for non‐LVRR.ConclusionLVRR also occurs in patients with MAVD, post‐operative MR and coronary artery disease were independent risk factors for non‐LVRR.

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Mid-term outcomes of surgical aortic valve replacement using a mosaic porcine bioprosthesis with concomitant mitral valve repair

Sugimori,

Nakao,

Okada

et al. 2023

Heart Vessels

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Effect of Transcatheter Aortic Valve Replacement on Concomitant Mitral Regurgitation and Its Impact on Mortality

Cited by 40 publications

References 18 publications

The Common Combination of Aortic Stenosis with Mitral Regurgitation: Diagnostic Insight and Therapeutic Implications in the Modern Era of Advanced Echocardiography and Percutaneous Intervention

The Common Combination of Aortic Stenosis with Mitral Regurgitation: Diagnostic Insight and Therapeutic Implications in the Modern Era of Advanced Echocardiography and Percutaneous Intervention

Left ventricular reverse remodeling after transcatheter aortic valve replacement for predominant aortic stenosis and mixed aortic valve disease

Mid-term outcomes of surgical aortic valve replacement using a mosaic porcine bioprosthesis with concomitant mitral valve repair

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