Abstract 18248: Should We Refrain to Perform TAVI Procedures in Patients with a Mitral Regurgitation? Insights from the FRANCE 2 Registry
Background: The presence of mitral regurgitation (MR) is an independent predictor of mortality after conventional aortic valve replacement for aortic stenosis. The predictive value of pre-procedural MR on clinical outcome after TAVI is unknown.
Methods: 3,195 consecutive patients were enrolled between January 2010 and October 2011 in 33 centres. MR was graded according to pre-procedural transthoracic echocardiography (TTE) as none/trivial (=0), mild (=1), moderate (=2), moderate-to-severe (=3), or severe (=4). The mean age was 82±7 years; 49% were female and mean logistic EuroSCORE was 21.9±14.3. Balloon (BE) and self-expendable (SE) devices were implanted in 66.9% and 33.1% of patients, respectively. Approaches were transarterial (transfemoral: 74.6%; subclavian: 5.8%), transapical (17.8%), and transaortic (1.8%).
Results: Pre-procedural TTE showed no MR in 32% of cases, a grade 1 MR in 46% of cases, a grade 2 MR in 20% of cases and a grade 3-4 in 2% of cases. Procedural success rate was 96.9%. Actuarial 1 year mortality was 19.5%. By univariate analysis, pre-procedural MR grade≥2, MR Grade=1 and MR Grade=0 were associated with a 1 year mortality rate of 24.0%, 20.1% and 15.8%, respectively (p=0.002). By multivariate analysis, 4 independent baseline characteristics were associated with preprocedural MR: a higer Logistic EuroSCORE (p=0.0001), a lower ejection fraction (p=0.0002), a higher NYHA class (p=0.0007), and female gender (p=0.001). By multivariate Cox analysis, independent predictors of one-year mortality were: logistic EuroSCORE (p=0.0001), NYHA class (p=0.0001) and transapical approach (p=0.0005). The presence of preprocedural MR was not significantly associated with 1-year mortality (p=0.31). Results did not differ when analyses were restricted only to BE or only to SE devices.
Conclusion: A mild (grade1) or a moderate (grade 2) MR preprocedural is associated with a higher 1-year mortality after TAVI. However, since preprocedural MR is associated with a higher NYHA class or a higher logistic Euroscore, pre-procedural MR is not an independent predictor of mortality. These findings suggest that, in itself, the presence of a mild or a moderate MR should not refrain from performing TAVI and should not impact the type of valve to be used
- © 2012 by American Heart Association, Inc.