Abstract
The aim of this study was to evaluate the impact of transcatheter aortic valve implantation (TAVI) on mitral valve geometry and function. Eighty-four patients underwent TAVI. Forty-four (52%) patients received a balloon-expandable valve and 40 (48%) were implanted with a self-expandable valve. All patients underwent three-dimensional-volumetric transesophageal echocardiography of the mitral valve before and immediately after TAVI. A dedicated software was used for assisted semiautomatic measurement of mitral annular geometry. During systole, the anterior to posterior (AP) diameter was significantly reduced after the procedure (3.4 ± 0.5 cm vs 3.2 ± 0.5 cm; P < .05). The mitral annular area (10.8 ± 2.8cm2 vs 9.9 ± 2.6cm2 ; P < .05) as well as the tenting area (1.6 ± 0.7 cm2 vs 1.2 ± 0.6 cm2 ; P < .001) measured at mid-systole were reduced after TAVI. Diastolic measures were similar. Patients treated with balloon-expandable valves showed a significantly larger reduction in the AP diameter compared to self-expandable valves (-0.25 cm vs -0.11 cm; P < .05). The reduction of the annular area was higher in the balloon-expandable group (-1.2 ± 1.59 vs -0.22 ± 1.41; P < .05). Grade of mitral regurgitation did improve or remained stable after TAVI. TAVI significantly impacts the mitral valve and mitral annular geometry and morphology. The choice of the prosthesis (balloon- vs self-expandable) may be relevant for those changes.
Highlights
A relevant number of patients with severe aortic stenosis suffers from functional mitral regurgitation (MR).[1,2] Improvement in MR after aortic valve interventions has been described.[3,4] A common explanation for this phenomenon is the reduced end‐systolic load and pressure immediately after aortic valve replacement in patients with aortic stenosis and the long‐term positive effects of reverse remodeling.[5]
Patients treated with balloon‐expandable valves showed a significantly larger reduction in the anterior to posterior (AP) diameter compared to self‐ expandable valves (−0.25 cm vs −0.11 cm; P < .05)
Changes in the degree of MR may depend on the changes in mitral annular geometry after transcatheter aortic valve implantation (TAVI).[5]
Summary
A relevant number of patients with severe aortic stenosis suffers from functional mitral regurgitation (MR).[1,2] Improvement in MR after aortic valve interventions has been described.[3,4] A common explanation for this phenomenon is the reduced end‐systolic load and pressure immediately after aortic valve replacement in patients with aortic stenosis and the long‐term positive effects of reverse remodeling.[5]. The aim of this study was to evaluate the impact of transcatheter aortic valve implantation (TAVI) on mitral valve geometry and function. All patients underwent three‐dimensional‐volumetric transesophageal echocardiography of the mitral valve before and immediately after TAVI. The mitral annular area (10.8 ± 2.8cm[2] vs 9.9 ± 2.6cm[2]; P < .05) as well as the tenting area (1.6 ± 0.7 cm[2] vs 1.2 ± 0.6 cm[2]; P < .001) measured at mid‐systole were reduced after TAVI. Patients treated with balloon‐expandable valves showed a significantly larger reduction in the AP diameter compared to self‐ expandable valves (−0.25 cm vs −0.11 cm; P < .05). Conclusion: TAVI significantly impacts the mitral valve and mitral annular geometry and morphology. The choice of the prosthesis (balloon‐ vs self‐expandable) may be relevant for those changes
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