Abstract 3384: Natural History And Predictors Of Improvement Of Mitral Regurgitation After Percutaneous Aortic Valve Replacement.
Background: Significant mitral regurgitation (MR) is frequently present in elderly patients with calcific aortic stenosis (AS). The outcome of MR after isolated aortic valve replacement (AVR) has not been determined in cohorts of patients who were not candidates for mitral valve (MV) repair. The Revival II Trial studies the safety and efficacy of transcatheter percutaneous AVR (pAVR) in patients with unacceptable surgical risk. The study cohort is free of the selection bias found in studies where both valves might be repaired. The purpose of this report was to define the short-term outcome of moderate to severe MR after pAVR in this special cohort.
Methods: Echocardiography was performed at numerous time points before and after pAVR and vena-contracta (VC), a quantitative measure of MR, was performed. To define predictors of MR improvement, VC percent reduction tertiles were created. Pre-specified parameters including demographics, STS score, and measures of LV, AV and MV structure and function were compared between the good responders (GR - top tertile) and the poor responders (PR -remaining subjects).
Results: Of the 55 enrolled in the study, 35 had moderate to severe MR at baseline. These 35 patients were examined. The mean VC declined from 0.5±0.20 cm on baseline to 0.32±0.18 cm and 0.38±0.2 cm on 24 hours and 3 months respectively (P<0.05). The percent of patients with mitral annular calcification (MAC) was significantly lower in the GR compared to PR (20% vs. 62% respectively P<0.05). The rest of the pre-specified parameters did not differ significantly between GR and PR including age (85±5 vs. 82±6), gender, STS score, MV tethering height (7.8±3 mm 6.3±3 mm), MV tethering area (14±8 mm vs. 12±9 mm), percent change in AV area (336%±130 vs. 285%±180), percent change in mean systolic trans AV pressure (− 20%±8 vs. − 23%±10), MV leaflet thickening and baseline ejection fraction (47±15 vs. 45±18).
Conclusion: MR improves significantly after percutaneous AVR for AS. MAC was the only predictor of reduced MR improvement. These results suggest that careful evaluation of the MV is required in selecting patients for transcatheter percutaneous AVR.