Abstract
Mitral regurgitation (MR) is the most common valvular lesion in transcatheter aortic valve implantation (TAVI) recipients. This study aims to assess the long-term prognostic impact of baseline MR in TAVI patients. Methods: Adult patients who underwent TAVI were identified in the French National Hospital Discharge Database. All-cause and cardiovascular mortality, stroke, and rehospitalization with heart failure (HF) were compared in TAVI patients with and without baseline MR and tricuspid regurgitation (TR), respectively; the associations of MR and TR with the outcomes were assessed by Cox regression. Results: Baseline MR was identified in 8240 TAVI patients. Patients with baseline MR have higher yearly incidence of all-cause mortality (HR: 1.192, 95% confidence interval CI: 1.125–1.263), cardiovascular mortality (HR: 1.313, 95%CI: 1.210–1.425), and rehospitalization for heart failure (HF) (HR: 1.411, 95%CI: 1.340–1.486) compared to those without, except for stroke rate (HR: 0.988, 95%CI: 0.868–1.124). Neither baseline MR nor TR was an independent risk predictor for all-cause mortality or cardiovascular mortality in TAVI patients. Baseline MR was independently associated with rehospitalization for HF in TAVI patients. Conclusions: Baseline MR and TR were associated with increased all-cause and cardiovascular mortality post-TAVI, however, neither of them was independent predictor for all-cause or cardiovascular mortality.
Highlights
Transcatheter aortic valve implantation (TAVI) or replacement (TAVR) is the treatment of choice for symptomatic severe aortic stenosis (AS) in elderly patients with comorbidities and frailty who are not suitable for surgical valve replacement
No significant impact of Mitral regurgitation (MR) on post-transcatheter aortic valve implantation (TAVI) survival was reported in smaller cohorts [11,12], a meta-analysis demonstrated that significant MR was associated with increased 30-day and 1-year mortality [13]
The main findings from the study include: (1) baseline MR was associated with increased all-cause and cardiovascular mortality post-TAVI procedure; when adjusted for other baseline characteristics, it was not an independent risk factor for either of the mortality outcomes; (2) baseline tricuspid regurgitation (TR), like MR, was not an independent risk factor for mortality among TAVI recipients; (3) baseline MR and TR were associated with increased rehospitalization for heart failure (HF) post TAVI, and MR was an independent risk factor for rehospitalization for HF
Summary
Transcatheter aortic valve implantation (TAVI) or replacement (TAVR) is the treatment of choice for symptomatic severe aortic stenosis (AS) in elderly patients with comorbidities and frailty who are not suitable for surgical valve replacement. In this group of patients with high mortality risk, the short-term post-TAVI survival is satisfactory, and the longterm survival is acceptable; in a meta-analysis which included 13,857 TAVI patients with a mean age of 81.5 ± 7.0 years, the aggregated survival was 83%, 48%, and 28% at 1, 5, and 7 years, respectively [1]. Baseline moderate to severe TR and right ventricular dysfunction are associated with increased all-cause mortality post TAVI [17]
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
