Mitral regurgitation after transcatheter aortic valve replacement

Abstract

Patients undergoing transcatheter aortic valve replacement (TAVR) might have an associated significant MR that can potentially lead to left ventricular (LV) failure after procedure. Considering the specific alterations in the mitral valve in TAVR scenario and the widespread use of TAVR in recent years, it appears important to know and understand the anatomical, functional and clinical implications to develop adequate strategies for the future. Patients with severe mitral regurgitation (MR) have been generally excluded from randomized clinical trials, making poor the impact that associated MR can have on clinical outcomes after TAVR. Several factors must be considered whose presence influences the severity of MR.For example, the elevated prevalence of coronary disease with consequent ischemic MR may account for LV dilation observed at the end stage of aortic stenosis. Evidence randomized studies and registries suggests that the rate of concomitant moderate-to-severe MR in patients undergoing TAVR oscillates between 2% and 33%, and patients with moderate to severe MR may have hemodynamic frailty with clinical deterioration during mechanical intervention. Short-and long-term outcomes, including cardiac mortality, appear to be influenced by the existence of preoperative moderate-to-severe MR or by the postprocedural worsening of mild MR, generally due to adverse LV remodeling. The incidence and the prognostic effect of concomitant MR in patients undergoing TAVR requires specific attention as might trigger adjunctive strategy treatment which should be carefully evaluated in clinical trials.

Interference between Venus-A Valve and Anterior Mitral Valve Leaflets after Transcatheter Aortic Valve Replacement: Insight from FEops HEARTguide simulation

“…Being in close contact with the left fibrous trigone (2,17), the AML is prone to interference with the prosthetic valve. In fact, our previous study found that in patients with pure native aortic valve regurgitation, 14 of 61 (23.0%) patients who received Venus-A prosthesis implantation had significant PAI following TAVR (18).…”

Exploring the Operative Strategy for Secondary Mitral Regurgitation: A Systematic Review

“…The use of the MitraClip procedure is recommended in patients with disproportionate secondary mitral regurgitation in which severe MR is coupled with nonseverely dilated left ventricular chambers [95,96]. Although this new framework is a very attractive proposal, however, it does not find unanimous consensus and requires further deep investigation involving transcatheter heart valve therapy [113][114][115][116][117][118][119][120][121][122][123][124][125][126][127].…”

Transcatheter valve-in-valve implantation vs. reoperative mitral valve surgery for failing surgical prosthesis

“…TMViV-T is presently considered in the United States and Europe for the management of deteriorated MV (TMViV) or mitral ring (TMViR) prostheses in patients at high risk for standard surgical approach [17,18] . Unlike Mitraclip therapy, in which the legislative endorsement is based on the results reported from the Endovascular Valve Edge-to-Edge Repair randomized Study (EVEREST) [19] , there is poor evidence on the survival benefit in patients who have undergone TMViV/TMViR for deteriorated bioprostheses compared to those who had redo surgery for SVD of MV [3,14,15,17,19] .…”

“…Both procedures had the same enrollment method for the patients who were considered suitable for the use of devices, therefore 349 persons from 98 sites were included in the US registry from 2013 to 2015 [26] . Nevertheless, the recent literature shows that the transcatheter procedure with the use of Mitraclip has a slight advantage over TMViV-T due to a better understanding of the pathophysiology of mitral rigurgitation and the normalization of the geometry [2][3][4]8,9,[27][28][29][30] .…”

“…The increase in the number of mitral valve repair operations, with a rise in the number of biological prostheses implanted in younger patients, has resulted in higher incidences of reoperative mitral valve surgery. Bioprosthesis replacement for deterioration or failed repairs and mitral annular calcification (MAC) pose ongoing challenges to the surgical management of patients requiring repeat valve surgery (Re-MVS) [1][2][3][4] .…”