Abstract 11158: Clinical Impact of Concomitant MR Among Patients Undergoing Transcatheter Aortic Valve Replacement

Abstract

Background: Mitral regurgitation (MR) is seen in patients with severe aortic stenosis (AS) undergoing transcatheter aortic valve replacement (TAVR). However, clinical outcomes in these patients have varied. The purpose of this study is to assess outcomes and changes in EF after TAVR in patients with concomitant MR. Methods: Retrospective chart review from March 2018-June 2020 identified all TAVR patients from the University of Illinois, Chicago. MR was assessed as none, mild, moderate, or severe regurgitation on baseline transthoracic echocardiogram. Patients were included if they demonstrated 6 or 12-month follow-up after valve replacement. Outcomes included all-cause mortality, major adverse cardiovascular events (MACE), clinically significant bleeding, and improvement in EF category, which included normal (50-70%), mildly (40-49%), moderately (30-39%), or severely (<30%) reduced. Results: 118 patients (age 76±10 years, 79% male, 46% white) followed up at 6-months and 112 at 12-months. Of these, 33% had baseline MR with 79% being mild and 21% moderate. Patients with AS+MR were more likely to have atrial fibrillation (41.0 vs. 19.0%, p=0.01) and an EF<50% (33.3 vs. 8.9%, p=0.001) compared to those with AS only. After TAVR, patients with MR were more likely to show improvements in EF category at 6 months (19.4 vs. 5.5%, p=0.039, Fig. 1). In those with AS+MR vs. AS only, there were no differences in all-cause mortality (12.8 vs. 5.1%, p=0.14), MACE (17.9 vs. 8.9%, p=0.15), or bleeding (10.3 vs. 6.3%, p=0.45) at 6 months. There were also no differences in all-cause mortality (16.2 vs. 14.7%, p=0.83), MACE (24.3 vs. 20.0%, p=0.60), or bleeding (13.5 vs. 10.7%, p=0.66) at 12 months. Conclusion: At 6 and 12 months after TAVR, patients with AS+MR experienced similar clinical outcomes as compared to those with only AS. Patients with AS+MR were more likely to show increases in EF 6 months after valve replacement. Our results suggest that patients with AS+MR stand to benefit after TAVR.