Persistent mitral regurgitation after TAVR foreshadows disease in some – NewsDio

NEW YORK (Reuters Health) Patients with low-flow and low-gradient aortic stenosis (LFLG-AS) who do not show improvement in mitral regurgitation after transcatheter aortic valve replacement (TAVR) face a higher risk of mortality, according to a substudy of a multi-center registry. "Some degree of mitral regurgitation, usually of functional origin, is common in patients with LFLG-AS and improves in a significant proportion after TAVR. However, lack of improvement is associated with worse outcomes," said Dr. Josep Rodes -Cabau of Laval University, in Quebec, Canada, told Reuters Health by email.

It is known that patients with LFLG-AS have a higher perioperative mortality and worse long-term outcomes than those with high-grade AS and / or preserved left ventricular ejection fraction (LVEF), Dr. Rodes-Cabau and his colleagues point out in JACC: Cardiovascular Interventions The impact of mitral regurgitation has not been clear. To investigate, the researchers identified 308 TAVI candidates with LFLG-AS in the true or pseudo-severe transcatheter aortic valve aortic valve implant registry (TOPAS-TAVI). At the start of the study, 118 (38.3%) had mild mitral regurgitation (MR) and 115 (37.3%) had moderate to severe MR.

A total of 138 (44.8%) patients died after a median follow-up of two years. Moderate or higher baseline MRI had no effect on mortality.

At one year, MRI improved in 44.3% of patients and remained unchanged or worsened in 55.7%. The lack of improvement was associated with greater risks of all-cause mortality (risk ratio, 2.02) and cardiac mortality (HR, 3.03), both statistically significant findings. This was also true for hospitalization in general and rehospitalization for cardiac causes. A larger final diastolic basal diameter of the left basal ventricle and a greater increase in LVEF were independent predictors of improved MRI. "These patients can benefit from closer follow-up within the year after TAVR, and an intervention directed at the mitral valve can be considered if significant mitral regurgitation persists," said Dr. Rodes-Cabau.

Dr. Colin M. Barker, director of Interventional Cardiology at the Vanderbilt Heart and Vascular Institute in Nashville, Tennessee, told Reuters Health via email: "This is a small but very interesting record. The authors showed that in patients with LFLG AS and significant concomitant MR treated with TAVR, the MR in more than half of these patients remained the same or worsened.This group, (with) significant MR after TAVR, had a higher risk of mortality, rehospitalization and heart complications congestive failure. " "These data should be reproduced in a prospective adjudicated study, but they are still very convincing," said Dr. Barker, who was not involved in the study. "The opportunities in this population are twofold: 1. Determine which patients will not have an improvement in MR after TAVR, and 2. Clarify the appropriate patients, the timing and modality for a beneficial mitral valve intervention. Clinically, these they remain very challenging patients to administer. " In an accompanying editorial, Dr. Martin J. Swaans of St. Antonius hospital in Nieuwegein, the Netherlands, says the findings show that "there is still hope for a special category of patients with TAVR with concomitant mitral valve dysfunction and poor performance. ventricular, especially in the presence of functional mitral regurgitation. " Dr. Swaans added in an email to Reuters Health that TAVR has expanded "mainly in two directions: more and more patients at lower risk are treated with TAVR and, on the other hand, more and more complex patients receive this treatment. border between treating or not treating is difficult to extract and difficult cases with multiple valve involvement and poor ventricle can create doubts. "

SOURCE: https://bit.ly/39SJZEn and https://bit.ly/2Pfw8jB JACC: Cardiovascular Interventions, online February 12, 2020.

. (tagsToTranslate) cardiac surgeries (t) cardiac surgery (t) transcatheter aortic valve replacement (TAVR) (t) transcatheter aortic valve implant (TAVI) (t) percutaneous aortic valve replacement (t) mitral regurgitation (t) regurgitation ( mitral) (t) mitral valve insufficiency (t) mitral insufficiency (t) aortic stenosis (t) aortic stenosis (t) valvar aortic stenosis (t) congenital heart disease (t) congestive heart failure (t) congestive heart fa

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Persistent mitral regurgitation after TAVR foreshadows disease in some - NewsDio