P5576Outcomes and clinical impact of mitral regurgitation in patients with aortic stenosis undergoing with transcatheter aortic valve replacement

Abstract

Abstract Background Many patients undergoing Trancatheter aortic valve replacement (TAVR) for aortic stenosis also have significant mitral regurgitation (MR). We sought to understand the association of concomitant MR with TAVR clinical outcomes, as well changes in MR after TAVR. Methods Patients who underwent TAVR at our center, between April 2008 to December 2017, were studied, with longer-term clinical outcomes. Results Of 667patients, 92 (13.8%) had moderate MR, and 47 (2.1%) had severe MR. At 3.2±2.2 years, mortality was 39.4%, 46.1%, 39.1%, 57.6% and 50% and heart failure (HF) rehospitalization was 7%, 7.9%, 17.6%, 21.9% and 46.2% (p<0.001) in the no, mild, moderate, moderate-severe and severe MR patients, respectively. After procedure, 64 patients (9.9%) had moderate MR and 24 patients (3.7%) had severe MR. At follow-up, the mortality was 35.9%, 46.5%, 48.4%, 52.9% and 85.7%, p<0.001 and HF rehospitalization 9.1%, 5.5%, 23.4%, 35.3% and 40% in the no, mild, moderate, moderate-severe and severe MR patients, respectively. MR improved early after TAVI grade in 88 patients (13.2%). Baseline MR is not associated with mortality (HR= 0.883 [95 CI 0.708–1.102], p=0.114), but MR post-TAVR was associated with increase risk of mortality (HR= 1.539 [95 CI 1.187–1.996], p=0.001. In 7 patients with persistent MR received percutaneous mitral repair with MitraClip®. Conclusions In our series, Moderate or severe MR after TAVR is associated with increased mortality or HF rehospitalization, this increased risk may be attributable to the minority of patients whose MR does not improve and could benefit from percutaneous mitral procedures (Mitraclip®).