Effect of Transcatheter Aortic Valve Replacement on the Mitral Valve Apparatus and Mitral Regurgitation

Abstract

A lthough mitral regurgitation (MR), including functional MR, is present in a large proportion of patients who undergo transcatheter aortic valve replacement (TAVR) for severe aortic stenosis, it is predominantly left untreated.1 Previous articles reported not only the influence of moderate or severe MR on clinical outcomes after TAVR but also the effect of TAVR on MR degree after the implantation of the Edwards SAPIEN or the Medtronic CoreValve. [1][2][3][4][5][6][7] Particularly after the implantation of the SAPIEN, short-term reduction of MR has been observed in previous reports.1,3-6 However, there is a paucity of investigation that demonstrates the effect of TAVR on mitral valve anatomy, including mitral leaflet coaptation and identification of the cause of acute MR reduction with or without mitral leaflet tethering. The aims of the present study were to (1) demonstrate the effect of the SAPIEN deployment on mitral valve anatomy, including mitral leaflet coaptation by 3-dimensional (3D) transesophageal echocardiography (TEE); and (2) identify the predictors of MR reduction with or without mitral leaflet tethering after TAVR. Clinical Perspective on p 351 Methods Study PopulationWe studied 332 consecutive patients with aortic stenosis who underwent TAVR and had intraprocedural 3D TEE from December 2010 to January 2013 in our institute. In total, 233 patients were excluded because pre-and postprocedural 3D TEE data, including mitral valve apparatus, were not available. We also excluded 9 patients with surgical history of mitral valve replacement, mitral valve repair, or aortic valve replacement. Finally, we included 90 patients in this study. Data were retrieved from our computerized database. This study was approved by the institutional review board. Comprehensive Transthoracic EchocardiographyComprehensive two-dimensional and Doppler transthoracic echocardiography (TTE) was performed routinely at our institute on all patients at baseline and 1 day after TAVR. The iE33 ultrasound system (Philips Medical Systems, Andover, MA) equipped with S5-1 phased array transducer (Philips Medical Systems) was used. In accordance with the American College of Cardiology/American Heart Association guideline, MR severity was graded as none, trivial, mild, moderate, or severe by primarily MR jet area, and, if necessary, other echocardiographic methods, including vena contracta, proximal isovelocity Background-The effect of transcatheter aortic valve replacement (TAVR) on the mitral valve apparatus and factors influencing the reduction of mitral regurgitation with or without mitral leaflet tethering after TAVR are poorly understood. The present 3-dimensional (3D) transesophageal echocardiography study aimed to elucidate early changes further in the structure and function of the mitral valve apparatus after TAVR. Methods and Results-We analyzed 90 patients (nontenting group, 56 patients and tenting group, 34 patients) who underwent TAVR using the Edwards SAPIEN and had intraprocedural 3D transesophageal echocardiography evaluat...

Echocardiographic follow‐up after transcatheter aortic valve replacement

“…At the same time, mitral annulus calcification and degenerative etiology of MR are negative predictors of MR severity improvement after TAVR, whereas functional etiology of MR is an important positive predictor of its improvement after TAVR, particularly, in the absence of significant PVR, severe PH and atrial fibrillation . In a study of 34 patients with moderate or severe MR, the severity of MR reduced acutely as valvuloarterial impedance decreased . The MR improvement was more frequent in patients who received a balloon‐expandable (66.7%) than in those implanted with self‐expandable valve (40.8%), probably due to a higher rate of postprocedural left bundle branch block and pacemaker implantation in the latter group, which may lead to LV dyssynchrony and reduced mitral valve closing forces.…”

Role of Multimodality Imaging in Transcatheter Aortic Valve Replacement

“…A small number (6–8%) of patients did have worsening of MR, the majority of which were progression from none to trivial or trivial to mild. Improvement in MR is generally due to a decrease in valvulo arterial impedance post TAVR . However, in patients with tethered mitral leaflets, commonly seen in a dilated LV and functional MR, improvement in tethering was noted to play a role in the improvement of MR .…”

Association of postprocedural aortic regurgitation with mitral regurgitation worsened after transcatheter aortic valve replacement

“…Recently, transcatheter aortic valve replacement (TAVR) has been undergone in many advanced age patients with severe aortic stenosis (AS) . Although any degree of mitral regurgitation (MR) including functional MR is present in a large proportion of those patients, it is predominantly left untreated .…”

“…Recently, transcatheter aortic valve replacement (TAVR) has been undergone in many advanced age patients with severe aortic stenosis (AS) . Although any degree of mitral regurgitation (MR) including functional MR is present in a large proportion of those patients, it is predominantly left untreated . Previous papers demonstrated not only the influence of significant MR on clinical outcomes after TAVR but also the impact of TAVR on a degree of MR .…”