Thus, the objective of this study was to assess the impact of MR improvement on long-term outcome and to determine underlying imaging predictors in patients with MR undergoing TAVR.Ĩ36 consecutive patients underwent TAVR for severe native aortic stenosis between January 2013 and August 2016 at Cologne University Heart Center. So far, however, it is unclear, (a) whether MR improvement after TAVR impacts on survival and (b) whether echocardiographic parameters can predict the resolution and persistence of MR in this patient population, respectively. This is important since significant baseline or residual MR is associated with an increased mortality after TAVR. However, MR remains unchanged or even worsens in some patients and predictors for MR improvement are not well defined. In contrast to surgery, concomitant MR is typically left untreated at the time of TAVR, given that MR severity has been reported to decrease in surgical patients. Over the last decade, transcatheter aortic valve replacement (TAVR) has evolved to clinical standard for the treatment of severe aortic stenosis in patients with increased risk for conventional surgery. Combined aortic and mitral valve surgery yielded good long term functional results at the cost of a substantially increased operative mortality. In surgical patients, there is a general consensus that in the presence of severe MR double-valve surgery is indicated, whereas the treatment of concomitant moderate MR is unclear. However, data on multi-valve disease are scarce and, as a result, US- and European guideline recommendations for the management of multi-valve disease are limited. Relevant concomitant mitral regurgitation (MR) is present in up to one-third of patients with severe aortic stenosis. Graphic abstractįactors associated with MR persistence or regression after TAVR These data call for close follow up and additional mitral valve treatment in this subgroup. Persistence of severe MR following TAVR can be predicted using selected parameters derived from TTE-imaging. Unresolved severe MR is a critical determinant of long term mortality following TAVR. A score based on these parameters selected groups with differing probability of MR ≤ 2 + post TAVR ranging from 10.5 to 94.4% (AUC 0.816 P < 0.001), and was predictive for 2-year mortality. Baseline parameters including non-severe baseline MR, the extent of mitral annular calcification and large annular dimension (≥ 32 mm) predicted the likelihood of an improvement to MR ≤ 2 +. MR improvement to ≤ 2 + was associated with significantly better survival compared to patients with persistent MR ≥ 3 +. MR improved in 50% of patients following TAVR, with 44% regressing to MR ≤ 2 +. Resultsġ5.2% of patients presented with baseline MR ≥ 3 +, which was associated with a significantly decreased 2-year survival (57.7% vs. Morphological echo analysis was performed to determine predictors of MR improvement. 2-year mortality was related to the degree of baseline and discharge MR. Mitral regurgitation was graded by transthoracic echocardiography before and after TAVR in 677 consecutive patients with severe aortic stenosis. BackgroundĬoncomitant MR is a frequent finding in patients with severe aortic stenosis but usually left untreated at the time of TAVR. The objective of this study was to assess imaging predictors of mitral regurgitation (MR) improvement and to evaluate the impact of MR regression on long-term outcome in patients undergoing transcatheter aortic valve replacement (TAVR).
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