Effect of Transcatheter Aortic Valve Replacement on Concomitant Mitral Regurgitation and Its Impact on Mortality
Por:
Witberg, G, Codner, P, Landes, U, Schwartzenberg, S, Barbanti, M, Valvo, R, De Backer, O, Ooms, JF, Islas, F, Marroquin, L, Sedaghat, A, Sugiura, A, Masiero, G, Werner, P, Armario, X, Fiorina, C, Arzamendi, D, Santos-Martinez, S, Fernandez-Vazquez, F, Baz, JA, Steblovnik, K, Mauri, V, Adam, M, Merdler, I, Hein, M, Ruile, P, Grasso, C, Branca, L, Estevez-Loureiro, R, Benito-Gonzalez, T, Amat-Santos, IJ, Mylotte, D, Andreas, M, Bunc, M, Tarantini, G, Sinning, JM, Nombela-Franco, L, Sondergaard, L, Van Mieghem, NM, Finkelstein, A, Kornowski, R
Publicada:
14 jun 2021
Ahead of Print:
1 jun 2021
Resumen:
OBJECTIVES The purpose of this study was to examine the impact of residual mitral regurgitation (MR) on mortality in patients undergoing transcatheter aortic valve replacement (TAVR).
BACKGROUND MR is common in patients undergoing TAVR. Data on optimal management of patients with significant MR after TAVR are limited.
METHODS The registry consisted of 16 TAVR centers (n = 7,303). Outcomes of patients with $ moderate versus lesser grade MR after TAVR were compared.
RESULTS In 1,983 (27.2%) patients, baseline MR grade was $ moderate. MR regressed in 874 (44.1%) patients and persisted in 1,109 (55.9%) after TAVR. Four-year mortality was higher for those with MR persistence, but not for those with MR regression after TAVR, compared with nonsignificant baseline MR (43.8% vs. 35.1% vs. 32.4%; hazard ratio [HR]: 1.38; p = 0.008; HR: 1.02; p = 0.383, respectively). New York Heart Association functional class III to IV after TAVR was more common in those with MR persistence vs. regression (14.4% vs. 3.9%; p < 0.001). In a propensity score-matched cohort (91 patients' pairs), with significant residual MR after TAVR who did or did not undergo staged mitral intervention, staged intervention was associated with a better functional class through 1 year of follow-up (82.4% vs. 33.3% New York Heart Association functional class I or II; p < 0.001), and a numerically lower 4-year mortality, which was not statistically significant (64.6% vs. 37.5%; HR: 1.66; p = 0.097).
CONCLUSIONS Risk stratification based on improvement in MR and symptoms after TAVR can identify patients at increased mortality risk after TAVR. These patients may benefit from a staged transcatheter mitral intervention, but this requires further proof from future studies. (C) 2021 by the American College of Cardiology Foundation.
Filiaciones:
Witberg, G:
Rabin Med Ctr, Dept Cardiol, 100 Jabutinski St, IL-98100 Petah Tiqwa, Israel
Tel Aviv Univ, Sackler Sch Med, Tel Aviv, Israel
Codner, P:
Rabin Med Ctr, Dept Cardiol, 100 Jabutinski St, IL-98100 Petah Tiqwa, Israel
Tel Aviv Univ, Sackler Sch Med, Tel Aviv, Israel
Landes, U:
Rabin Med Ctr, Dept Cardiol, 100 Jabutinski St, IL-98100 Petah Tiqwa, Israel
Tel Aviv Univ, Sackler Sch Med, Tel Aviv, Israel
Schwartzenberg, S:
Rabin Med Ctr, Dept Cardiol, 100 Jabutinski St, IL-98100 Petah Tiqwa, Israel
Tel Aviv Univ, Sackler Sch Med, Tel Aviv, Israel
Barbanti, M:
Univ Catania, Div Cardiol, Catania, Italy
Valvo, R:
Univ Catania, Div Cardiol, Catania, Italy
De Backer, O:
Copenhagen Univ Hosp, Rigshosp, Heart Ctr, Copenhagen, Denmark
Ooms, JF:
Erasmus MC, Thoraxctr, Dept Cardiol, Rotterdam, Netherlands
Islas, F:
Hosp Clin San Carlos, Cardiovasc Inst, Inst Invest Sanitaria San Carlos, Madrid, Spain
Marroquin, L:
Hosp Clin San Carlos, Cardiovasc Inst, Inst Invest Sanitaria San Carlos, Madrid, Spain
Sedaghat, A:
Univ Klinikum Bonn, Herzzentrum Bonn, Bonn, Germany
Sugiura, A:
Univ Klinikum Bonn, Herzzentrum Bonn, Bonn, Germany
Masiero, G:
Univ Padua, Med Sch, Dept Cardiac Thorac & Vasc Sci, Padua, Italy
Werner, P:
Med Univ Vienna, Div Cardiac Surg, Vienna, Austria
Armario, X:
Natl Univ Ireland, Galway Univ Hosp, Dept Cardiol, Galway, Ireland
Fiorina, C:
Spedali Civil Brescia, Cardiovasc Dept, Brescia, Italy
Arzamendi, D:
Hosp St Creu & St Pau Barcelona, Barcelona, Spain
Santos-Martinez, S:
Hosp Clin Univ Valladolid, Ctr Invest Biomed Red Enfermedades Cardiovasc, Valladolid, Spain
Fernandez-Vazquez, F:
Univ Hosp Leon, Dept Cardiol, Leon, Spain
Baz, JA:
Hosp Alvaro Cunqueiro, Serv Cardiol, Vigo, Spain
Steblovnik, K:
Univ Med Ctr, Dept Cardiol, Ljubljana, Slovenia
Mauri, V:
Univ Cologne, Fac Med, Heart Ctr, Dept Cardiol, Cologne, Germany
Adam, M:
Univ Cologne, Fac Med, Heart Ctr, Dept Cardiol, Cologne, Germany
Merdler, I:
Tel Aviv Univ, Sackler Sch Med, Tel Aviv, Israel
Tel Aviv Sourasky Med Ctr, Tel Aviv, Israel
Hein, M:
Univ Heart Ctr Freiburg Bad Krozingen, Dept Cardiol & Angiol 2, Bad Krozingen, Germany
Ruile, P:
Univ Heart Ctr Freiburg Bad Krozingen, Dept Cardiol & Angiol 2, Bad Krozingen, Germany
Grasso, C:
Univ Catania, Div Cardiol, Catania, Italy
Branca, L:
Spedali Civil Brescia, Cardiovasc Dept, Brescia, Italy
Estevez-Loureiro, R:
Hosp Alvaro Cunqueiro, Serv Cardiol, Vigo, Spain
Benito-Gonzalez, T:
Hosp Alvaro Cunqueiro, Serv Cardiol, Vigo, Spain
Amat-Santos, IJ:
Hosp Clin Univ Valladolid, Ctr Invest Biomed Red Enfermedades Cardiovasc, Valladolid, Spain
Mylotte, D:
Natl Univ Ireland, Galway Univ Hosp, Dept Cardiol, Galway, Ireland
Andreas, M:
Med Univ Vienna, Div Cardiac Surg, Vienna, Austria
Bunc, M:
Univ Med Ctr, Dept Cardiol, Ljubljana, Slovenia
Tarantini, G:
Univ Padua, Med Sch, Dept Cardiac Thorac & Vasc Sci, Padua, Italy
Sinning, JM:
Univ Klinikum Bonn, Herzzentrum Bonn, Bonn, Germany
Nombela-Franco, L:
Hosp Clin San Carlos, Cardiovasc Inst, Inst Invest Sanitaria San Carlos, Madrid, Spain
Sondergaard, L:
Copenhagen Univ Hosp, Rigshosp, Heart Ctr, Copenhagen, Denmark
Van Mieghem, NM:
Erasmus MC, Thoraxctr, Dept Cardiol, Rotterdam, Netherlands
Finkelstein, A:
Tel Aviv Univ, Sackler Sch Med, Tel Aviv, Israel
Tel Aviv Sourasky Med Ctr, Tel Aviv, Israel
Kornowski, R:
Rabin Med Ctr, Dept Cardiol, 100 Jabutinski St, IL-98100 Petah Tiqwa, Israel
Tel Aviv Univ, Sackler Sch Med, Tel Aviv, Israel
Bronze, Green Published
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