Transcatheter aortic implantation of the Edwards-SAPIEN bioprosthesis: Insights on early benefit of TAVI on mitral regurgitation

Evaluation of mitral regurgitation by an integrated 2D echocardiographic approach in patients undergoing transcatheter aortic valve replacement

“…Furthermore, a trend for more improvement in patients with functional etiology was not seen, which was to be expected from literature revealing coaptation of the otherwise normal MV leaflets, and persistent restriction of leaflet mobility in organic (calcified) MR [11,18]. This similar change for both etiologies was also seen in the studies of Tzikas et al, Unger et al and Almasood et al [12,15,42] Moreover, previous studies showed in particular an improvement in MR depending on the implanted prosthesis type [8,12,19,35].Mainly self-expandable valves seem to be at risk for deep implants, resulting in the valve cage impinging on the anterior MV leaflet, and thereby increasing MR [12]. Nevertheless, this correlation was not observed in our study.…”

“…Preexisting physical conditions such as AF, poor LV function, high LV volumes, and large LAVI (particularly seen in patients with MR grade ≥ 2) [8,11,16] may contribute to higher mortality rates observed in the short-term [14,29,46]. However, after 1-year follow-up a regression of concentric myocardial hypertrophy due to a decrease in ventricular afterload, and/or reverse remodeling that lead to changes in LV shape and geometry, may influence MV hemodynamics and therefore these confounding variables [11,12,16,18,19,35]. A second explanation is that the clinical profiles of patients with MR grade ≥ 2 and < 2 were similar in our study.…”

“…The importance of correct and consistent MR grading in patients with AS is related to previous studies in conventional aortic valve surgery, in which concomitant moderate MR has demonstrated to be an independent risk factor for mortality and morbidity, and may improve significantly in a selected group of patients avoiding unnecessary double valve surgery [13][14][15]. However, the predictive value of MR on clinical outcome after TAVR is still controversial, and discrepant results have been reported in terms of direction, magnitude and predictors of MR changes following TAVR [11,12,[16][17][18][19].…”

Impact of TAVI on Mitral Regurgitation: A Prospective Echocardiographic Study

“…Aortic gradient reduction and reverse remodeling can reduce MR after surgical aortic valve replacement (AVR) surgery . However, studies describing changes in MR in patients undergoing transcatheter aortic valve implantation (TAVI) are insufficient, and the reported data are contradictory . These studies have been limited by the dimension of the sampling sets, retrospective design, and a lack of quantitative MR assessment.…”

Transcutaneous Aortic Valve Implantation in Patients with Combined Aortic Stenosis and Mitral Regurgitation: Does the Choice of Prosthesis Matter?

“…There are currently limited data available to determine the optimal prosthesis for patients with combined AS and MR. Studies to date have demonstrated more favorable outcomes using the lower profile Edwards Sapien valve with MR improvement rates >50% and rates of worsening ≤1% . By contrast, studies utilizing the CoreValve showed improvement in MR in 12–34%, worsening in 22–44%, and no change in 47–55% .…”