Abstract 13323: Impact of Transcatheter Aortic Valve Replacement on the Mitral Valve Apparatus and Mitral Regurgitation: A Real-Time Three-Dimensional Transesophageal Echocardiography Study
Backgrounds: The impact of transcatheter aortic valve replacement (TAVR) on the mitral valve apparatus and factors influencing reduction of mitral regurgitation (MR) with or without mitral leaflet tethering after TAVR are poorly understood. The present three-dimensional (3D) transesophageal echocardiography (TEE) study aimed to further elucidate early changes in structure and function of the mitral valve apparatus after TAVR.
Methods and Results: In this study, we analyzed 90 patients (Non-Tenting group: 56 patients and Tenting group: 34 patients) who underwent TAVR using the Edwards Sapien device and underwent intra-procedural 3D TEE evaluation of the mitral valve. Of all patients, MR improved in 54%, remained the same in 38% and worsened in 8%. There were no differences in mitral annular 3D parameters before and after prosthetic deployment in both groups. In Tenting group, tenting area (p <0.01) (Figure) and tenting height (p <0.01) were decreased and coaptation length was increased (p <0.05) after TAVR. In a multivariate analysis, the predictors of improved MR one day after TAVR were the tenting area change (Odds ratio: 7.12; 95% CI: 1.02-49.7; p <0.05) and the decrease of valvulo-arterial impedance (Zva) (Odds ratio: 18.48; 95% CI: 1.01-336.7; p <0.05) in Tenting group and only the decrease of Zva (Odds ratio: 11.24; 95% CI: 1.36-92.6; p <0.05) in Non-Tenting group.
Conclusions: Acute improvement in MR after TAVR is predominantly related to Zva as global left ventricular hemodynamics and mitral leaflet tethering change.
- © 2013 by American Heart Association, Inc.