Mitral Regurgitation After Transcatheter Aortic Valve Replacement: Prognosis, Imaging Predictors, and Potential Management

• Published in: JACC. Cardiovascular interventions 2016-08, Vol.9 (15), p.1603-1614
• Main Authors: Cortés, Carlos, Amat-Santos, Ignacio J, Nombela-Franco, Luis, Muñoz-Garcia, Antonio J, Gutiérrez-Ibanes, Enrique, De La Torre Hernandez, José M, Córdoba-Soriano, Juan G, Jimenez-Quevedo, Pilar, Hernández-García, José M, Gonzalez-Mansilla, Ana, Ruano, Javier, Jimenez-Mazuecos, Jesús, Castrodeza, Javier, Tobar, Javier, Islas, Fabian, Revilla, Ana, Puri, Rishi, Puerto, Ana, Gómez, Itziar, Rodés-Cabau, Josep, San Román, José A
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Aortic Valve - diagnostic imaging; Aortic Valve - physiopathology; Aortic Valve - surgery; Aortic Valve Stenosis - complications; Aortic Valve Stenosis - diagnostic imaging; Aortic Valve Stenosis - physiopathology; Aortic Valve Stenosis - surgery; Area Under Curve; Balloon Valvuloplasty; Echocardiography, Doppler, Color; Echocardiography, Transesophageal; Female; Humans; Male; Mitral Valve - diagnostic imaging; Mitral Valve - physiopathology; Mitral Valve Insufficiency - complications; Mitral Valve Insufficiency - diagnostic imaging; Mitral Valve Insufficiency - physiopathology; Mitral Valve Insufficiency - therapy; Multidetector Computed Tomography; Odds Ratio; Predictive Value of Tests; Recovery of Function; Retrospective Studies; Risk Factors; ROC Curve; Severity of Illness Index; Time Factors; Transcatheter Aortic Valve Replacement - adverse effects; Transcatheter Aortic Valve Replacement - mortality; Treatment Outcome
• ISSN: 1876-7605
• DOI: 10.1016/j.jcin.2016.05.025

This study sought to analyze the clinical impact of the degree and improvement of mitral regurgitation in TAVR recipients, validate the main imaging determinants of this improvement, and assess the potential candidates for double valve repair with percutaneous techniques. Many patients with severe aortic stenosis present with concomitant mitral regurgitation (MR). Cardiac imaging plays a key role in identifying prognostic factors of MR persistence after transcatheter aortic valve replacement (TAVR) and for planning its treatment. A total of 1,110 patients with severe aortic stenosis from 6 centers who underwent TAVR were included. In-hospital to 6-month follow-up clinical outcomes according to the degree of baseline MR were evaluated. Off-line analysis of echocardiographic and multidetector computed tomography images was performed to determine predictors of improvement, clinical outcomes, and potential percutaneous alternatives to treat persistent MR. Compared with patients without significant pre-TAVR MR, 177 patients (16%) presented with significant pre-TAVR MR, experiencing a 3-fold increase in 6-month mortality (35.0% vs. 10.2%; p < 0.001). After TAVR, the degree of MR improved in 60% of them. A mitral annular diameter of >35.5 mm (odds ratio: 9.0; 95% confidence interval: 3.2 to 25.3; p