Incidence, associated factors and evolution of non-severe functional mitral regurgitation in patients with severe aortic stenosis undergoing aortic valve replacement

Caballero-Borrego, Juan; Gómez‐Doblas, Juan José; Cabrera-Bueno, Fernando; García‐Pinilla, José Manuel; Melero, José M.; Porras, Carlos; Olalla, Eduardo; Galván, Eduardo de Teresa

doi:10.1016/j.ejcts.2008.03.055

Cited by 72 publications

(68 citation statements)

References 17 publications

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“…[1][2][3]6,7 The findings of the present analysis, performed on the as-treated population of cohort A of the PARTNER trial, add considerably to the understanding of the impact of moderate/severe MR in high-risk patients undergoing isolated TAVR and SAVR. Importantly, improvements in symptoms and functional class were found with both TAVR and SAVR, regardless of the severity of MR.…”

Section: Discussionmentioning

confidence: 99%

Impact of Preoperative Moderate/Severe Mitral Regurgitation on 2-Year Outcome After Transcatheter and Surgical Aortic Valve Replacement

Barbanti¹,

Webb²,

Hahn³

et al. 2013

Circulation

154

106

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Background— The effect of preoperative mitral regurgitation (MR) on clinical outcomes of patients undergoing transcatheter aortic valve replacement (TAVR) is controversial. This study sought to examine the impact of moderate and severe MR on outcomes after TAVR and surgical aortic valve replacement (SAVR). Methods and Results— Data were drawn from the randomized Placement of Aortic Transcatheter Valve (PARTNER) Trial cohort A patients with severe, symptomatic aortic stenosis undergoing either TAVR (n=331) or SAVR (n=299). Both TAVR and SAVR patients were dichotomized according to the degree of preoperative MR (moderate/severe versus none/mild). At baseline, moderate or severe MR was reported in 65 TAVR patients (19.6%) and 63 SAVR patients (21.2%). At 30 days, among survivors who had isolated SAVR/TAVR, moderate/severe MR had improved in 25 SAVR patients (69.4%) and 30 TAVR patients (57.7%), was unchanged in 10 SAVR patients (27.8%) and 19 TAVR patients (36.5%), and worsened in 1 SAVR patient (2.8%) and 4 TAVR patients (5.8%; all P =NS). Mortality at 2 years was higher in SAVR patients with moderate or severe MR than in those with mild or less MR (49.8% versus 28.1%; adjusted hazard ratio, 1.73; 95% confidence interval, 1.01–2.96; P =0.04). In contrast, MR severity at baseline did not affect mortality in TAVR patients (37.0% versus 32.7%, moderate/severe versus none/mild; hazard ratio, 1.14; 95% confidence interval, 0.72–1.78; P =0.58; P for interaction=0.05). Conclusions— Both TAVR and SAVR were associated with a significant early improvement in MR in survivors. However, moderate or severe MR at baseline was associated with increased 2-year mortality after SAVR but not after TAVR. TAVR may be a reasonable option in selected patients with combined aortic and mitral valve disease. Clinical Trial Registration— URL: http://www.clinicaltrials.gov . Unique identifier: NCT00530894.

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Section: Discussionmentioning

confidence: 99%

Impact of Preoperative Moderate/Severe Mitral Regurgitation on 2-Year Outcome After Transcatheter and Surgical Aortic Valve Replacement

Barbanti¹,

Webb²,

Hahn³

et al. 2013

Circulation

154

106

View full text Add to dashboard Cite

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“…the role of functional etiology as a predictor of Mr improvement after taVr is highlighted by toggweiler et al 12 in a study on 478 patients. depressed lV ejection fraction and larger lV diameters have also been associated with better improvement of Mr 7,25,26,27 , while calcific degeneration of mitral valve 25 , atrial fibrillation, large left atrial size and pulmonary arterial hypertension have been found to be associated with lack of improvement in Mr after aVr 6,28,29,30 . Furthermore, a 2010 study by Matsumura et al 31 identified preoperative tenting area, tenting height and mitral annulus area -measured by standard echocardiography -as independent predictors of persistent Mr after aVr.…”

Section: Impact Of Avr On Concomitant Mr: Is There An Improvement?mentioning

confidence: 99%

Concomitant significant mitral regurgitation in patients with aortic valve stenosis undergoing valve replacement: Practical indications

Iudice¹,

Galderisi²

2015

ICFJ

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Significant mitral regurgitation (MR) - either of structural or functional origin - is a frequent condition in patients with severe aortic stenosis (AS), candidate to aortic valve replacement (AVR), and raises the problem whether or not to intervene on mitral valve at the same time. Surgical risk related to the double valve intervention is still significantly higher compared to isolated AVR and international guidelines do not always give definite indications in the presence of multiple valve disease. Furthermore, the increasing diffusion of transcatheter aortic valve replacement for patients at high surgical risk has risen the problem of leaving the concomitant MR untreated. This review is an attempt to give a practical guide for the decision-making process about the treatment strategy of patients with concomitant severe AS and significant MR, analyzing the impact of a persistent MR on prognosis after surgical or transcatheter AVR, the main predictors of MR improvement after isolated AVR - according to the current literature – and displaying the emerging approach involving transcatheter treatment of both AS and MR.

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“…Легкая сте-пень MН у больных с первичным дегенеративным пора-жением клапана хорошо компенсируется в течение мно-гих лет, однако даже незначительная функциональная MН, особенно у больных с низкой фракцией выброса, имеет негативное прогностическое значение. Ряд данных свидетельствует о том, что наличие промежуточных сте-пеней МН после протезирования АК значительно ухуд-шает отдаленные результаты лечения [13,61,71,79].…”

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“…В то же время, согласно некоторым данным [13], после протезирования АК митральная недостаточность снижает-ся в среднем лишь на 50%. Это наблюдение свидетельствует в пользу агрессивного подхода с сопутствующей пластикой МК при ПАК.…”

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“…Тем не менее считают, что персистенция или ухудшение значимой MН после ПАК требует рассмотрения сопутствующей коррекции МК у этих пациентов [21]. Недавно проведенный метаанализ вы-явил, что сопутствующая умеренная МН может увеличи-вать раннюю и отдаленную смертность после ПАК, пред-полагая, что сопутствующую коррекцию МК следует рас-сматривать даже в присутствии умеренной MН, независи-мо от ее причины [13]. Метаанализ L. Harling и соавт.…”

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Functional mitral regurgitation in aortic valve disease patients: state of the art

Belov¹,

Charchyan²,

Salagaev³

2016

Kardiol. serdechno-sosud. khir.

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Incidence, associated factors and evolution of non-severe functional mitral regurgitation in patients with severe aortic stenosis undergoing aortic valve replacement

Abstract: The presence of intermediate degree mitral regurgitation in patients undergoing isolated aortic valve replacement increases morbidity and mortality. However, a high percentage of those who do survive experience disappearance or improvement of the mitral regurgitation.

Cited by 72 publications

References 17 publications

Impact of Preoperative Moderate/Severe Mitral Regurgitation on 2-Year Outcome After Transcatheter and Surgical Aortic Valve Replacement

Impact of Preoperative Moderate/Severe Mitral Regurgitation on 2-Year Outcome After Transcatheter and Surgical Aortic Valve Replacement

Concomitant significant mitral regurgitation in patients with aortic valve stenosis undergoing valve replacement: Practical indications

Functional mitral regurgitation in aortic valve disease patients: state of the art

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