Impact of Preoperative Moderate/Severe Mitral Regurgitation on 2-Year Outcome after Transcatheter and Surgical Aortic Valve Replacement: Insight from the PARTNER (Placement of AoRTic TraNscathetER Valve) Trial Cohort A
Background—The effect of preoperative mitral regurgitation (MR) on clinical outcomes of patients undergoing transcatheter aortic valve replacement (TAVR) is controversial. This study sought to examine the impact of moderate and severe MR on outcomes after TAVR and surgical aortic valve replacement (SAVR).
Methods and Results—Data were drawn from the randomized PARTNER Trial cohort A of patients with severe, symptomatic aortic stenosis undergoing either TAVR (n=331) or SAVR (n=299). Both TAVR and SAVR patients were dichotomized according to the degree of preoperative MR (moderate/severe vs. none/mild). At baseline, moderate or severe MR was reported in 65 TAVR (19.6%), and 63 SAVR patients (21.2%). At 30 days, among survivors who had isolated SAVR/TAVR, moderate/severe MR had improved in 25 SAVR (69.4%) and 30 TAVR (57.7%) patients, was unchanged in 10 SAVR (27.8%) and 19 TAVR (36.5%) patients, and worsened in 1 SAVR (2.8%) and 4 TAVR (5.8%) patients (all p=NS). Mortality at 2 years was higher in SAVR patients with moderate or severe MR than those with ≤mild MR (49.8% vs. 28.1%; adjusted hazard ratio (HR): 1.73; 95% confidence interval (CI)[1.01-2.96], p=0.04). In contrast, MR severity at baseline did not affect mortality in TAVR patients (37.0% vs 32.7%, moderate/severe vs. none/mild; hazard ratio [HR]: 1.14; 95% confidence interval [CI] [0.72-1.78], p=0.58) (pinteraction=0.05).
Conclusions—Both TAVR and SAVR were associated with a significant early improvement in MR in survivors. However, moderate or severe MR at baseline was associated with increased 2-year mortality after SAVR, but not after TAVR. TAVR may be a reasonable option in selected patients with combined aortic and mitral valve disease.
Clinical Trial Registration Information—http://clinicaltrials.gov. Identifier: NCT00530894.
- aortic valve stenosis
- transcatheter aortic valve implantation
- aortic valve replacement
- mitral regurgitation
- Received May 17, 2013.
- Accepted August 30, 2013.