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J Am Coll Cardiol. 2012 Jun 5;59(23):2068-74. doi: 10.1016/j.jacc.2012.02.020. Epub 2012 Apr 4.

Transcatheter aortic valve replacement: outcomes of patients with moderate or severe mitral regurgitation.

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1
St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada.

Abstract

OBJECTIVES:

The aim of this study was to evaluate the impact of mitral regurgitation (MR) on outcomes after transcatheter aortic valve replacement (TAVR) and the impact of TAVR on MR.

BACKGROUND:

Little is known of the influence of MR on outcomes after TAVR.

METHODS:

The outcomes of patients with mild or less (n = 319), moderate (n = 89), and severe (n = 43) MR were evaluated after TAVR at 2 Canadian centers.

RESULTS:

Patients with moderate or severe MR had a higher mortality rate than those with mild or less MR during the 30 days after TAVR (adjusted hazard ratio: 2.10; 95% confidence interval: 1.12 to 3.94; p = 0.02). However, the mortality rates after 30 days were similar (adjusted hazard ratio: 0.82; 95% confidence interval: 0.50 to 1.34; p = 0.42). One year after TAVR, moderate MR had improved in 58%, remained moderate in 17%, and worsened to severe in 1%, and 24% of patients had died. Severe MR had improved in 49% and remained severe in 16%, and 35% of patients had died. Multivariate predictors of improved MR at 1 year (vs. unchanged MR, worse MR, or death) were a mean transaortic gradient ≥ 40 mm Hg, functional (as opposed to structural) MR, the absence of pulmonary hypertension, and the absence of atrial fibrillation.

CONCLUSIONS:

Moderate or severe MR in patients undergoing TAVR is associated with a higher early, but not late, mortality rate. At 1-year follow-up, MR was improved in 55% of patients with moderate or severe MR at baseline. Improvement was more likely in patients with high transaortic gradients, with functional MR, without pulmonary hypertension and without atrial fibrillation.

PMID:
22483326
DOI:
10.1016/j.jacc.2012.02.020
[Indexed for MEDLINE]
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