Abstract
BackgroundPatients after transcatheter aortic valve replacement (TAVR) and persistent severe mitral regurgitation (MR) are increasingly treated with percutaneous edge-to-edge mitral valve repair (PMVR). The impact of a former TAVR on PMVR procedures is not clear.Methods and resultsWe retrospectively analyzed 332 patients undergoing PMVR using the MitraClip system with respect to procedural and clinical outcome. 21 of these 332 patients underwent TAVR before PMVR. Intra-procedural transthoracic (TTE) and transesophageal echocardiograms (TEE) immediately before and after clip implantation as well as invasive hemodynamic measurements were evaluated. At baseline, we found a significantly smaller mitral valve anterior-posterior diameter in the TAVR cohort (p < 0.001). A reduction of MR by at least three grades was achieved in a smaller fraction in the TAVR cohort as compared to the cohort with a native aortic valve (p = 0.02). Accordingly, we observed a smaller post-procedural cardiac output in the TAVR cohort (p = 0.02).ConclusionPMVR in patients who had a TAVR before, is associated with altered MR anatomy before and a reduced improvement of MR after the procedure. Future larger and prospective studies will have to determine, whether a previous TAVR influences long-term clinical outcome of patients undergoing PMVR.
Highlights
Patients with severe heart valve defects not eligible for conventional surgery can be treated with interventional techniques
In all patients receiving percutaneous edge-to-edge mitral valve repair (PMVR), we compared the cohort with a native aortic valve and the cohort with previous transcatheter aortic valve replacement (TAVR) with regard to procedural and clinical parameters such as procedural success, reduction of mitral regurgitation (MR) and increase in cardiac output
There were significant differences regarding the baseline characteristics between the cohort with a native aortic valve and the cohort with previous TAVR
Summary
Patients with severe heart valve defects not eligible for conventional surgery can be treated with interventional techniques. Patients with aortic stenosis and aortic valve regurgitation undergo transaortic valve replacement (TAVR) and patients with mitral regurgitation (MR) are treated with percutaneous mitral valve edge-to-edge repair (PMVR) using for example the MitraClip system. In a relevant fraction of these patients both aortic stenosis and MR are present. As a matter of fact, 20% to 30% of patients undergoing TAVR present with moderate to severe MR [1]. There is insufficient data investigating, if the MitraClip procedure is influenced by the presence of a surgical or interventional aortic valve prosthesis. Patients after transcatheter aortic valve replacement (TAVR) and persistent severe mitral regurgitation (MR) are increasingly treated with percutaneous edge-to-edge mitral valve repair (PMVR). The impact of a former TAVR on PMVR procedures is not clear
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