140TRANSCATHETER AORTIC VALVE IMPLANTATION REDUCES GRADE OF CONCOMITANT MITRAL AND TRICUSPID VALVE REGURGITATION AND PULMONARY HYPERTENSION

• Published in: Interactive cardiovascular and thoracic surgery 2013-10, Vol.17 (suppl_2), p.S103-S103
• Main Authors: Wilbring, M., Tugtekin, S.M., Ritzmann, M., Schmidt, T., Matschke, K., Kappert, U., Alexiou, K.
• Format: Article
• Language: English
• ISSN: 1569-9293; 1569-9285
• DOI: 10.1093/icvts/ivt372.140

Objectives: Concomitant mitral (MR) and tricuspid valve regurgitation (TR), in combination with pulmonary hypertension, is frequently seen in patients undergoing transcatheter aortic valve implantation (TAVI). We assessed the impact of transapical TAVI on this clinical configuration. Methods: Since 2008, 508 patients have been treated with TAVI at our institution. One-hundred and sixteen of these (22.8%) presented with concomitant moderate MR and TR. The mean patient age was 81.5 ± 4.9 years. The logistic EuroSCORE averaged 18.1 ± 11.5%. The transapical approach with the Edwards SAPIEN bioprosthesis (mean labeled size 25.2 ± 1.9 mm) was used in all patients. The preoperative grade of MR and TR, as well as right ventricular systolic pressure (RVSP) and tricuspid annular plane systolic excursion (TAPSE), were compared with postoperative values at discharge. Results: A significant reduction in mean MR (2.0 ± 0.3 to 1.5 ± 0.5, P < 0.001) and TR (1.9 ± 0.5 to 1.5 ± 0.6, P < 0.01) was observed. Similarly, RVSP decreased significantly (52 ± 13 mmHg to 42 ± 14 mmHg, P < 0.001). The TAPSE as a surrogate for right ventricular function showed no significant change, but decreased by trend (21.6 ± 6.6 mm to 19.6 ± 4.5 mm, P = 0.07). No significant changes were observed concerning left atrial or right ventricular diameter (P = 0.1094 and P = 0.834 respectively). The mean hospital stay was 12.9 ± 6.1 days. Survival rate after a mean follow-up of 539 ± 401 days was 79.3%, one-year survival was 80.0%, and three-year survival 72.2%. Observed survival rates were comparable with those observed in TAVI patients without concomitant mitral or tricuspid valve regurgitation (P = 0.561). Conclusions: TAVI in patients with concomitant mitral and tricuspid valve regurgitation postoperatively reduces the grade of regurgitation and concomitant pulmonary hypertension. The clinical results seem to be not inferior compared with TAVI patients without concomitant mitral and tricuspid regurgitation.