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Am J Cardiol. 2015 Apr 1;115(7):942-9. doi: 10.1016/j.amjcard.2015.01.022. Epub 2015 Jan 15.

Meta-analysis of the impact of mitral regurgitation on outcomes after transcatheter aortic valve implantation.

Author information

  • 1Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California.
  • 2Department of Cardiology, University Hospital, Lille, France.
  • 3Department of Cardiology, Mayo Clinic, Rochester, Minnesota.
  • 4Department of Cardiology, Clinical Institute S. Ambrogio, Milan, Italy.
  • 5Department of Cardiology, Karolinska University Hospital, Stockholm.
  • 6Department of Cardiology, University of Catania, Catania, Italy; St. Paul's Hospital, Vancouver, Canada.
  • 7Luzerner Kantonsspital, Lucerne, Switzerland.
  • 8Guys and St. Thomas' Hospital, London, United Kingdom.
  • 9German Heart Center, Munich, Germany.
  • 10St. Paul's Hospital, Vancouver, Canada.
  • 11Columbia University Medical Center, New York-Presbyterian Hospital, New York, New York.
  • 12Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California. Electronic address: makkarr@cshs.org.

Abstract

Significant mitral regurgitation (MR) constitutes an important co-existing valvular heart disease burden in the setting of aortic valve stenosis. There are conflicting reports on the impact of significant MR on outcomes after transcatheter aortic valve implantation (TAVI). We evaluated the impact of MR on outcomes after TAVI by performing a meta-analysis of 8 studies involving 8,927 patients reporting TAVI outcomes based on the presence or absence of moderate-severe MR. Risk ratios (RRs) were calculated using the inverse variance random-effects model. None-mild MR was present in 77.8% and moderate-severe MR in 22.2% of the patients. The presence of moderate-severe MR at baseline was associated with increased mortality at 30 days (RR 1.35, 95% confidence interval [CI] 1.14 to 1.59, p = 0.003) and 1 year (RR 1.24, 95% CI 1.13 to 1.37, p <0.0001). The increased mortality associated with moderate-severe MR was not influenced by the cause of MR (functional or degenerative MR; RR 0.90, 95% CI 0.62 to 1.30, p = 0.56). The severity of MR improved in 61 ± 6.0% of patients after TAVI. Moderate-severe residual MR, compared with none-mild residual MR after TAVI, was associated with significantly increased 1-year mortality (RR 1.48, 95% CI 1.31 to 1.68, p <0.00001). In conclusion, baseline moderate-severe MR and significant residual MR after TAVI are associated with an increase in mortality after TAVI and represent an important group to target with medical or transcatheter therapies in the future.

Copyright © 2015 Elsevier Inc. All rights reserved.

PMID:
25779617
[PubMed - indexed for MEDLINE]
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