Concomitant Mitral Regurgitation Research Articles

Estimation of Risk Factors for Cardiogenic Shock in Takotsubo Cardiomyopathy: A Retrospective Study

<p>Introduction: Presentation of Takotsubo cardiomyopathy(TCM) widely varies amongst the patients, ranging from asymptomatic patients to cardiogenic shock or even cardiac arrest. The underlying risk factors inherent to the patient that predispose to a catastrophic presentation have not been delineated well in the past.</p><p>Objective: To distinguish risk factors and presenting characteristics of patients diagnosed with cardiogenic shock from TCM.</p><p>Methods: Total 51 angiography-confirmed TCM patients admitted in Upstate Hospital from 2010 – 2014 were compared retrospectively, 13 presenting with cardiogenic shock.</p><p>Results: While TCM was predominantly common in elderly females, four of the total six male TCM patients presented with shock (Odds ratio= 8.0, p=0.027). TSH was higher in cardiogenic shock group. Patients with shock had significantly higher incidence of ST elevations on EKG and higher peak troponins. Moreover, ST elevations were predominantly in the inferior, anteroseptal and lateral leads in the shock group as compared to only the septal leads in the control group. Echocardiography revealed lower LV ejection fraction, LV outflow tract obstruction and concomitant significant mitral regurgitation in shock patients. No correlation was found with age, BMI, coronary disease risk factors (diabetes, hypertension, smoking), coincident infection, electrolyte imbalance, QTc interval length.</p><p>Conclusion: Risk factors and pathophysiology for cardiogenic shock in TCM were identified. TCM in males is rare, but male gender is a risk factor for shock.</p>

Implantation of CARILLON® Mitral Contour System with transvenous left ventricular lead in place.

Cardiac resynchronisation therapy (CRT) is an established treatment option for chronic heart failure patients with left bundle branch block. Although a concomitant functional mitral regurgitation is often reduced by CRT, many patients need additional mitral valve repair. Placing a CARILLON® Mitral Contour System (CMCS) over a transvenous CRT lead is currently not recommended, since both of them are implanted in the coronary sinus (CS). The aim of this study was to investigate the feasibility of sequential implantation of a transvenous LV lead followed by CMCS implantation, and to assess LV lead performance and possibility of extraction. Standard transvenous LV leads were implanted in the CS of five female sheep. After establishing regular anatomical position with stable electrical parameters of the LV lead, a CMCS was additionally implanted in the CS. After an observation period of 100days, lead performance and positions of lead and CMCS were studied. Sequential implantation of the two components was feasible in sheep. After 100days, all leads showed regular measurements of impedance, threshold, and sensing. There was no migration of either the LV lead or the CMCS. In all cases, the LV lead could be completely extracted without migration of the CMCS. There were no acute or long-term complications. In an animal model of healthy adult sheep, implantation of CMCS with a transvenous LV lead already in place was feasible and without major problems with either the CMCS or the LV lead. Electrical performance of the LV leads was excellent. All LV leads could be extracted without migration of the CMCS.

Short-term clinical outcomes and risk factors associated with in-hospital mortality in patients undergoing off-pump coronary artery bypass grafting

Objective: To explore short-term clinical outcomes and risk factors associated with in-hospital mortality in patients undergoing off-pump coronary artery bypass grafting (OPCABG) and establish a prediction model for in-hospital mortality. Methods: The clinical data of patients undergoing OPCABG in Beijing Anzhen Hospital between January 2014 and January 2016 was retrospectively studied. Univariate analysis and logistic regression were applied to determine the potential risk factors, and then a prediction model for mortality was confirmed. The calibration and discrimination of the prediction model was finally tested. Results: A total of 2 546 patients who underwent OPCABG were recruited. In-hospital mortality of OPCABG was 0.7% (17 cases). Seven variables: female, age, left main disease >50%, low left ventricular ejection fraction (LVEF), acute myocardial infarction before surgery, operative status (selective or emergent), moderate concomitant mitral valve regurgitation were independently correlated with OPCABG mortality (all P<0.05). The result of Hosmer-Lemeshow test was χ(2)=5.912, P=0.676. The area under receiver-operating characteristic curve (ROC) was 0.881. Conclusions: OPCABG is safe and effective for myocardial revascularization in a short term. The following risk factors are associated with an increased operative mortality of OPCABG: male, age, left main disease >50%, low LVEF, acute myocardial infarction before surgery, operative status (selective or emergent), moderate concomitant mitral valve regurgitation. The prediction model established by above-mentioned potential risk factors was proven to perform well by statistical tests.

CHANGE IN AORTOMITRAL ANNULAR ANGLE AND ANTERIOR MITRAL VALVE LEAFLET LENGTH AFTER TRANSCATHETER AORTIC VALVE REPLACEMENT: IMPLICATIONS FOR TRANSCATHETER MITRAL VALVE REPLACEMENT?

Background: Patients undergoing transcatheter aortic valve replacement (TAVR) often have concomitant severe mitral regurgitation. A portion of these patients are not anatomical candidates for a mitraclip procedure. Transcatheter mitral valve replacement (TMVR) is a promising alternative, but has a

Transcatheter treatment of severe tricuspid regurgitation using the edge-to-edge repair technique.

The aim of this study was to investigate the procedural feasibility and short-term durability of the transcatheter tricuspid valve edge-to-edge repair technique in highly symptomatic patients with severe tricuspid regurgitation (TR). Eighteen consecutive patients suffering from severe right-sided heart failure (NYHA Class III-IV), primarily due to moderate to severe tricuspid regurgitation, were included in the study. Applying a modified steering technique for the clip delivery system, six patients were treated for isolated severe TR, while 12 patients were treated for moderate to severe TR and concomitant severe mitral regurgitation. The primary objectives were procedural success, defined as reduction of at least one TR grade, and 30-day echocardiographic and clinical outcomes. A total of 41 clips (2.3±0.7 per patient) were placed into the tricuspid valve of high surgical risk patients (EuroSCORE II: 10±8%). Procedural success was achieved in all patients; no MACCE occurred in hospital. The presence of a TR grade ≥3 was reduced from 94% (17 patients) before the procedure to 33% (six patients) at 30-day follow-up (p<0.001). Sixteen patients (89%) reported an improvement in NYHA functional class at 30 days. Applying a modified steering technique, the edge-to-edge repair technique can be successfully used for the treatment of TR. At 30-day follow-up, the short-term durability of TR reduction appeared promising and the majority of patients improved clinically. Further studies with larger patient populations and longer follow-up have to define the role of this novel treatment option for patients with right-sided heart failure and severe TR.

The impact of functional vs degenerative mitral regurgitation on clinical outcomes among patients undergoing transcatheter aortic valve implantation

Among patients undergoing transcatheter aortic valve implantation (TAVI), concomitant mitral regurgitation (MR) has been associated with adverse prognosis. We aimed to assess long-term clinical outcomes according to MR etiology. In a single-center registry of consecutive patients undergoing TAVI, we investigated the impact of functional (FMR) vs degenerative (DMR) MR on cardiovascular (CV) mortality throughout 2years of follow-up. Among 603 patients (mean age 82.4±5.7years, 55% female) undergoing TAVI, 149 patients had moderate or severe MR (24.7%). Functional MR and DMR were documented in 53 (36%) and 96 (64%) patients, respectively. At 2years, patients with FMR and DMR had higher rates of CV mortality (30.2% vs 32.4%) as compared with patients with no MR (14.6%; FMR vs no MR: hazard ratio [HR] 2.32, 95% CI 1.34-4.02, P=.003; DMR vs no MR: HR 2.56, 95% CI 1.66-3.96, P<.001). In adjusted analyses, DMR was associated with an increased risk of CV mortality throughout the 2-year follow-up (adjusted HR 2.21, 95% CI 1.4-3.49, P=.001) as compared with FMR (adjusted HR 1.13, 95% CI 0.59-2.18, P=.707). Relevant MR was postprocedurally significantly reduced in both the DMR and FMR groups, whereas improvement of a decreased left ventricular ejection fraction was predominantly seen in the FMR group as compared with baseline. Patients with severe, symptomatic aortic stenosis undergoing TAVI complicated by moderate or severe MR portend impaired prognosis. Particularly, patients with DMR are at increased risk for CV mortality during long-term follow-up.

Mitral Regurgitation After TranscatheterAorticValve Replacement: Prognosis, Imaging Predictors, and Potential Management.

This study sought to analyze the clinical impact of the degree and improvement of mitral regurgitation in TAVR recipients, validate the main imaging determinants of this improvement, and assess the potential candidates for double valve repair with percutaneous techniques. Many patients with severe aortic stenosis present with concomitant mitral regurgitation (MR). Cardiac imaging plays a key role in identifying prognostic factors of MR persistence after transcatheter aortic valve replacement (TAVR) and for planning its treatment. A total of 1,110 patients with severe aortic stenosis from 6 centers who underwent TAVR were included. In-hospital to 6-month follow-up clinical outcomes according to the degree of baseline MR were evaluated. Off-line analysis of echocardiographic and multidetector computed tomography images was performed to determine predictors of improvement, clinical outcomes, and potential percutaneous alternatives to treat persistent MR. Compared with patients without significant pre-TAVR MR, 177 patients (16%) presented with significant pre-TAVR MR, experiencing a 3-fold increase in 6-month mortality (35.0% vs. 10.2%; p< 0.001). After TAVR, the degree of MR improved in 60% of them. A mitral annular diameter of >35.5 mm (odds ratio: 9.0; 95% confidence interval: 3.2 to 25.3; p<0.001) and calcification of the mitral apparatus by multidetector computed tomography (odds ratio: 11.2; 95% confidence interval: 4.03 to 31.3; p< 0.001) were independent predictors of persistent MR. At least 14 patients (1.3% of the entire cohort, 13.1% of patients with persistent MR) met criteria for percutaneous mitral repair with either MitraClip (9.3%) or a balloon-expandable valve (3.8%). Significant MR is not uncommon in TAVR recipients and associates with greater mortality. In more than one-half of patients, the degree of MR improves after TAVR, which can be predicted by characterizing the mitral apparatus with multidetector computed tomography. According to standardized imaging criteria, at least 1 in 10 patients whose MR persists after TAVR could benefit from percutaneous mitral procedures, and even more could be treated with MitraClip after dedicated pre-imaging evaluation.

Dynamics of Concomitant Functional Mitral Regurgitation in Patients with Aortic Stenosis Undergoing TAVI.

The aim of this study was to investigate the echocardiographic features of functional mitral regurgitation (MR) in patients with aortic stenosis (AS) pre- and post-trans catheter aortic valve implantation (TAVI). The study subjects consisted of 79 patients with severe AS, who underwent TAVI. The echocardiographic parameters related to MR severity prior to TAVI and the change in these parameters and MR severity within one month after implantation were retrospectively evaluated. The mean left ventricular ejection fraction (LVEF) was 53 ± 12%, and the mean MR severity was 1.2 ± 0.7. Among the baseline parameters, age (p = 0.019, r = 0.264), LV mass (p = 0.017, r = 0.269), deceleration time (DT) (p = 0.019, r = -0.266), left atrial diameter (p = 0.003, r = 0.325), were related to pre-procedure MR severity. After TAVI, the grade of MR (1.2 ± 0.7 vs. 0.8 ± 0.6, p < 0.001) and MR duration (43 ± 19% vs. 31 ± 23%, p < 0.001) were significantly decreased. The grade of pre-procedural MR (p < 0.001) was a predictor of residual MR after TAVI. However, there was not a significant change in the left ventricular echocardiographic parameters after TAVI [LVEF (53 ± 12 vs. 52 ± 11, p = 0.285), and LV mass (302 ± 84 vs. 306 ± 76 g, p = 0.495)]. In patients with severe AS, functional MR is related to age, LV mass, DT and left atrial diameter. TAVI improves MR in these patients, even before LV remodelling occurs.

Impact of baseline mitral regurgitation on short- and long-term outcomes following transcatheter aortic valve replacement

The prevalence of concomitant significant mitral regurgitation (MR) in patients with severe aortic stenosis (AS) undergoing transcatheter aortic valve replacement (TAVR) ranges from 2% to 33%. The impact of significant MR on post-TAVR outcomes remains controversial. The data from a cohort of patients with symptomatic severe AS undergoing TAVR at out institution were retrospectively analyzed. The last transthoracic echocardiogram (TTE) before the index TAVR procedure was selected as the baseline assessment of the degree of MR. The total study cohort (N = 589) was divided into 2 groups: significant ≥moderate MR (n = 68) versus nonsignificant <moderate MR (n = 521) at baseline. The 2 groups were compared in regard to baseline, imaging, procedural, and postprocedural characteristics. In-hospital, 30-day, and 1-year outcomes were assessed. Multivariate Cox regression survival analyses were performed to test the independent effect of ≥moderate MR on mortality at short- and long-term follow-up periods. Patients with ≥moderate MR had a higher mortality rate versus patients with <moderate MR during the initial 30-day follow-up after TAVR (unadjusted log-rank P = .011, risk-adjusted P = .031, hazard ratio = 2.40, 95% CI 1.08-5.29). However, the mortality rates at 1-year follow-up postprocedure were similar between the 2 groups (unadjusted log-rank P = .553, risk-adjusted P = .331, hazard ratio = 0.70, 95% CI 0.35-1.43). Among the original ≥moderate group, 62.5% and 77.7% of patients had improved to <moderate MR at 30-day and 1-year follow-up, respectively. Moderate or greater MR in patients undergoing TAVR is associated with a higher 30-day but not 1-year mortality. A majority of the patients demonstrated significant improvement in MR following TAVR.

Prognostic impact and change of concomitant mitral regurgitation after surgical or transcatheter aortic valve replacement for aortic stenosis

BackgroundSignificant aortic stenosis (AS) is frequently associated with mitral regurgitation (MR) of varying degrees. We sought to assess the change in MR grade after the aortic valve procedure, to find predictors of MR improvement and finally to determine the prognostic impact of persistent MR. MethodsWe retrospectively analyzed a group of 101 AS patients who underwent aortic valve replacement (AVR) or transcatheter aortic valve implantation (TAVI) at our institution between January 2007 and March 2014 and who presented with MR grade 2 or higher on preoperative echocardiogram – 35 patients underwent an isolated AVR, 18 underwent TAVI, and the rest underwent a combined procedure, which included coronary artery bypass grafting. The mean follow-up was 28.5±21 months. ResultsMR improved significantly after the procedures (2.4±0.5 vs. 1.9±0.9, p<0.001) and a decline in the severity of MR was observed regardless of etiology (degenerative/post-rheumatic, functional/ischemic, combined) without significant changes between groups (p=0.667). Downgrading of MR severity was associated with improvement in ejection fraction (p=0.021) and reduction in the size of cardiac chambers, especially the left atrium (left atrial diameter, p<0.001). None of the preoperatively evaluated factors (severity of AS, MR etiology, ejection fraction, cardiac chamber dimensions, coronary artery disease, and New York Heart Association functional class) was a significant predictor of MR improvement. Persistence of higher degrees of MR was associated with a more frequent need for cardiovascular hospitalization, while the survival rate 3 years after procedure was not affected (p=0.146). ConclusionsIn the majority of AS patients, an aortic valve procedure leads to reduction in coexistent MR. A significant decrease in the severity of MR in our study was observed regardless of etiology and preoperative grade of MR. Persistence of higher degrees of MR was associated with increased patient morbidity.

Mitral and aortic regurgitation following transcatheter aortic valve replacement

ObjectiveTo analyse the impact of postprocedural mitral regurgitation (MR), in an interaction with aortic regurgitation (AR), on mortality following transcatheter aortic valve implantation (TAVI).MethodsTo assess the interaction between MR and...

Long-term results of surgical treatment of patients with aortic valve disease and functional mitral insufficiency

To analyze long-term surgical results in patients with aortic valve disease and concomitant mitral regurgitation (MR) depending on volume of valve surgery. It was studied 5-year results in 71 patients with aortic valve disease and different degree of mitral regurgitation. Patients were divided into 3 groups. Control group included 40 patients after aortic valve replacement (AVR) and no mitral insufficiency. The 2nd group consisted of 16 patients after AVR and concomitant mitral regurgitation degree 2-3. The 3rd group - 15 patients after aortic and mitral valve replacement. Mortality in long-term postoperative period, quality of life, incidence of complications and echocardiography data were analyzed. There was no significant improvement of mitral regurgitation after AVR. It was showed that persistent MR decreases remote survival and quality of life as well as deteriorates echocardiography data. Herewith these data in the 3rd group did not differ from the control group. Double-valve replacement may be advisable in patients with aortic valve disease and concomitant moderate MR because persistent MR deteriorates long-term However prolonged time of cardiopulmonary bypass, aortic cross-clamping, greater blood loss require comprehensive approach to advanced cardiac surgery.

0245: Echocardiographic and clinical outcome in patients undergoing trans-catheter aortic valve replacement with concomitant mitral regurgitation

Severe aortic stenosis (AS) is commonly associated with mitral regurgitation (MR) in patients undergoing transcatheter aortic valve replacement (TAVR). The natural history of MR is not well defined in this population. Consecutive high risk, inoperable patients undergoing TAVR between 2007 and 2011 for AS has echos at baseline and 1 year and were followed for clinical outcomes. MR severity was graded and patients were grouped as having minimal (none-mild) or significant (moderate- severe) MR. 164 patients underwent TAVR, reducing gradients from 47 to 10mHg. LVEF increased from 48% to 52% while pulmonary aretry systolic pressure (PAPS), LVESD and LVEDD were unchanged. Signficant MR patents had a median 1 grade reduction (p<0,0001) in MR at 1 year. Median LVEF increased by 2% (p=0.0412). Median LVESD decreased by 2.3mm±7.5 (p=0.039). Univariate analysis showed no significant predictors of MR reduction in significant MR patients. Functional and organic significant MR decreased after TAVR but only functional MR patients had improved LVEF (6%, p=0.034), PAPS (5.9mmHg, p=0.022) and LVESD (3.8mm, p=0.013). Multivariate analysis showed functional MR to be a predictor of improved LVEF and PAPS. Clinical outcomes at a mean follow-up of 925 days were not different in patients with significant vs minimal MR; however organic MR patients tended to have more events than functional MR patients (p=0.06). Significant MR patients undergoing TAVR for severe AS improved in LVEF and LVESD, particularly patients with functional MR. Organic MR is marginally predictive of cardiac complications in AS patients.

The beneficial effects of TAVI in mitral insufficiency.

BackgroundPrevious studies have suggested that concomitant mitral regurgitation (MR) is a risk factor for acute transcatheter aortic valve implantation (TAVI) failure, but may improve afterwards. Aim of this study was to assess the prevalence, clinical meaning and modifications of MR in patients undergoing TAVI.MethodsIn a retrospective, two-center (Potenza-San Carlo and Roma- San Camillo) study, from January 2010 to June 2014 we enrolled 165 consecutive patients (age =80 ± 5 years, 74 males, Ejection Fraction 51 ± 9 %) referred for TAVI with either Medtronic Core-ReValving System (in 114 patients, 69 %) or balloon-expandable Edwards SAPIEN/SAPIEN XT (in 51 patients, 31 %). All patients underwent TTE and TEE assessment of MR (from 1, mild to 4 = severe according to ESC latest guidelines) with core lab reading by a single observer blinded to patient identity and status. Assessment was performed at baseline (24 h prior to intervention) and at 1, 6, 12 and 24 months.ResultsMild-to-Moderate MR (grade 1–2) was present in 137 patients and Moderate-to-Severe MR (grade 3–4) was present in 28 patients. No significant differences were seen comparing perioperative mortality and morbidity between the two groups. In the group of preoperative MR grade 3–4 the mean decrease from MR pre-TAVI to MR at 1 month post-TAVI was 0.464 (p < 0.0001) and this improvement was persistent at 6 months (p < 0.0001) and at 12 months (p < 0.0001), with partial benefit loss at 1 and 2 years. The mean difference from Left Atrial volume post-TAVI at 1 month was 16.5 ml (p < 0.0001) and this improvement was persistent at 12 months 12.12 ml (p < 0.0001).ConclusionsTAVI effectively treats the aortic valve but as a beneficial by product also ameliorates concomitant MR. The presence of moderate-to-severe MR does not increase the acute risk of failure of TAVI. In successful procedures, the MR improves immediately and persistently.

Mitral regurgitation prior to transcatheter aortic valve implantation influences survival but not symptoms

BackgroundCurrent data about the impact of concomitant mitral regurgitation (MR) on outcome in patients who undergo transcatheter aortic valve implantation (TAVI) are conflicting. Our purpose was to analyze the clinical course of MR and to assess the influence of MR on survival and clinical status after TAVI. MethodsWe included 375 consecutive patients who underwent TAVI. MR grade and NYHA class were determined before TAVI and at follow-up. ResultsIn total 171 patients (46%) had MR grade≥2 at baseline and of these 29% improved to MR grade≤1 after TAVI. MR grade≤1 at baseline was present in 204 patients (54%) and of these 17% worsened to grade≥2 after TAVI. Improvement of MR was associated with absence of atrial fibrillation (OR: 2.35, 95%CI: 1.17–4.71, p=0.02). Worsening of MR was associated with moderate or more aortic valve regurgitation after TAVI (OR: 4.2, CI: 1.83–9.49, p=0.001). NYHA class improved at follow-up. Baseline MR grade did not determine the degree of clinical improvement (MR grade≤1: NYHA ≥3 from 67% to 17%; MR grade≥2: NYHA ≥3 from 69% to 14%). Although patients with MR grade≥2 at baseline improved symptomatically, this degree of MR was associated with reduced two year survival compared with patients with MR grade≤1(mortality 37% vs 26%; HR 1.99; 95% CI 1.27–3.13; p=0.003). ConclusionIn patients who undergo TAVI almost half have MR grade≥2 prior to the procedure. TAVI had no influence on MR grade at follow-up. Although patients with MR grade≥2 at baseline improved symptomatically after TAVI, concomitant MR at baseline significantly reduced two year survival.

Abstract 14145: Stroke Volume Index Predicts Mortality of Patients Undergoing Transcatheter Aortic Valve Implantation With Concomitant Mitral Regurgitation

Introduction: Patients with severe aortic stenosis frequently suffer from concomitant mitral regurgitation (MR), which implicates cardiac hemodynamic and clinical status. Hypothesis: We assessed the hypothesis that moderate/severe MR increases mortality of patients undergoing trancatheter aortic valve implantation (TAVI) and evaluated the possible predicting ability of pre-implantation echocardiographic assessment. Methods: We prospectively enrolled 119 patients, retrieved clinical and echocardiographic data before and 6 months after TAVI and divided patients in two groups: none/mild and moderate/severe MR. Clinical follow-up performed in a two-year period. A low mean gradient was assumed when &lt;40 mmHg, a low stroke volume index (SVi) when &lt;35ml/m2 and a low ejection fraction when &lt;45%. Statistical analysis of all-cause mortality performed with the Kaplan-Meier method and further evaluated with Cox proportional hazards analysis. Results: Seventy six patients (64%) had none/mild and 43 (36%) had moderate/severe MR. The baseline characteristics where evenly distributed among groups except for gender, coronary artery disease, chronic obstructive pulmonary disease and pulmonary arterial systolic pressure. The median follow-up time was 23 months (mean 22±13 months). During follow-up period the cumulative probability for mortality was significantly different between groups (none/mild MR: 14.5%, moderate/severe MR: 34.9%, p=0.006). In multivariate analysis, low SVi predicted mortality adjusted for moderate/severe MR and the variables that differed at baseline [HR: 5.1, 95% CI (2.21, 11.92), p=0.001], while other echocardiographic variables did not contribute to the final model although significant in univariate analysis. Conclusions: Patients undergoing TAVI with concomitant moderate or severe MR had increased risk for mortality in a two-year period. Pre-implantation low stroke volume index independently predicted mortality.

TCT-682 Impact of concomitant mitral regurgitation on mortality after transcatheter aortic valve replacement for severe aortic stenosis in high risk patients – results from a prospective single center registry

TCT-682 Impact of concomitant mitral regurgitation on mortality after transcatheter aortic valve replacement for severe aortic stenosis in high risk patients – results from a prospective single center registry

TCT-111 Impact of Concomitant Mitral Regurgitation Following Transcatheter Aortic Valve Replacement: Insights from the US TVT National Registry

TCT-111 Impact of Concomitant Mitral Regurgitation Following Transcatheter Aortic Valve Replacement: Insights from the US TVT National Registry

Patient and procedure selection for the prevention of prosthesis-patient mismatch following aortic valve replacement.

Prosthesis-patient mismatch (PPM) is frequent following surgical aortic valve replacement (SAVR) and is associated with an increased risk of morbidity and mortality. Preventive strategies to avoid or minimise PPM should be implemented in patients who are at high risk (i.e., patients with a small aortic annulus or those undergoing a valve-in-valve procedure within a small surgical bioprosthesis) and/or vulnerable to PPM (i.e., depressed left ventricular [LV] systolic function, severe LV hypertrophy, concomitant mitral regurgitation, and paradoxical low-flow, low-gradient aortic stenosis). Recent studies suggest that transcatheter aortic valve replacement (TAVR) may be superior to SAVR for the prevention of PPM and associated adverse cardiac events, particularly in the subset of patients with a small (<21 mm) aortic annulus. However, further randomised studies are needed to confirm the potential superiority of TAVR for this purpose.

Concomitant significant mitral regurgitation in patients with aortic valve stenosis undergoing valve replacement: Practical indications

&lt;p&gt;Significant mitral regurgitation (MR) - either of structural or functional origin - is a frequent condition in patients with severe aortic stenosis (AS), candidate to aortic valve replacement (AVR), and raises the problem whether or not to intervene on mitral valve at the same time. Surgical risk related to the double valve intervention is still significantly higher compared to isolated AVR and international guidelines do not always give definite indications in the presence of multiple valve disease. Furthermore, the increasing diffusion of transcatheter aortic valve replacement for patients at high surgical risk has risen the problem of leaving the concomitant MR untreated. This review is an attempt to give a practical guide for the decision-making process about the treatment strategy of patients with concomitant severe AS and significant MR, analyzing the impact of a persistent MR on prognosis after surgical or transcatheter AVR, the main predictors of MR improvement after isolated AVR - according to the current literature – and displaying the emerging approach involving transcatheter treatment of both AS and MR.&lt;/p&gt;&lt;p&gt;&lt;strong&gt; &lt;/strong&gt;&lt;/p&gt;