Interplay between Mitral Regurgitation and Transcatheter Aortic Valve Replacement with the CoreValve Revalving System: A Multicenter Registry
Background—Little is known of the prognostic significance of mitral regurgitation (MR) on transcatheter aortic valve replacement (TAVR), the impact of TAVR on MR severity, and the variables associated with possible post-TAVR improvement of MR. We evaluated these issues in a multicenter registry of patients undergoing CoreValve Revalving System-TAVR (CRS-TAVR).
Methods and Results—Among 1007 consecutive patients, 670(66.5%), 243(24.1%) and 94(9.3%) presented with none/mild, moderate, and severe MR, respectively. At 1-month post-TAVR, patients with severe or moderate MR showed comparable mortality rates (OR 1.1(0.7-1.55),p=0.2), but both were significantly higher compared to patients with mild/none MR [OR 2.2(1.78-3.28),p<0.001 and OR 1.9(1.1-3.3),p=0.02, respectively]. One-year mortality was also similar between patients with severe or moderate MR (HR 1.4 (0.94-2.4), p=0.06) and still significantly higher compared to patients with mild/none MR [HR 1.7(1.2-3.41),p<0.001, and HR 1.4(1.2-2.2),p=0.03, respectively]. Severe pulmonary hypertension(SPH), atrial fibrillation(AF), and MR more than mild, but not an improvement of ≥1 grade in MR severity, were independent predictors of mortality at 1-year. At 1-year, an improved MR was observed in 47% and 35% of patients with severe and moderate MR, respectively. The rate of "low implant" was consistent across groups with improved, unchanged or worsened MR. A functional etiology of MR, the absence of SPH and AF independently predicted the MR severity improvement.
Conclusions—Baseline MR greater than mild is associated with higher mortality after CRS-TAVR. A significant improvement of MR was more likely in patients with functional MR, without SPH or AF. The improvement of MR did not independently predict mortality.
- Received February 4, 2013.
- Revision received August 20, 2013.
- Accepted August 23, 2013.