Mitral Regurgitation in TAVR: The Complexity of Multivalvular Disease
Transcatheter aortic valve replacement (TAVR) has emerged as an alternative treatment for patients with symptomatic aortic stenosis (AS) who are at unacceptably high risk for conventional surgical aortic valve replacement (AVR).1, 2 Approximately 60,000 patients worldwide have undergone TAVR in the eleven years since it was introduced.3 While good procedural success and favorable clinical outcomes have been reported,4, 5 issues remain regarding the best patient selection for the procedure. Risk calculators commonly used to estimate the risk of valvular surgery, such as the logistic EuroSCORE and the Society of Thoracic Surgeons (STS) model, are not considered accurate in TAVR patients as they do not account for all clinical characteristics that may significantly impact procedural and post-procedural mortality. The current selection criteria are based on those used in randomized trials, and in conjunction with the clinical evaluation, echocardiography is a mainstay in the assessment of candidates for this procedure. Beyond the clinical and anatomic exclusion criteria, severe pulmonary hypertension with right ventricular dysfunction, very severe left ventricular (LV) systolic dysfunction (ejection fraction<20%) and severe mitral regurgitation (MR) are among the echocardiographic exclusions.6 Moreover, each of the commercially available prosthesis manufacturers presents its own recommendations for the procedure, with the CoreValve being more restrictive with respect to concomitant valvular disease.
- Received September 29, 2013.
- Accepted October 1, 2013.