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The effect of pre-procedural significant mitral regurgitation upon mortality after transcatheter aortic valve intervention for severe aortic stenosis

Session Poster session 4

Speaker Konstantinos Toutouzas

Event : ESC Congress 2016

  • Topic : valvular, myocardial, pericardial, pulmonary, congenital heart disease
  • Sub-topic : Valvular Heart Disease – Treatment
  • Session type : Poster Session

Authors : A Michelongona (Athens,GR), M Drakopoulou (Athens,GR), K Toutouzas (Athens,GR), S Brili (Athens,GR), O Kaitozis (Athens,GR), K Stathogiannis (Athens,GR), A Synetos (Athens,GR), G Latsios (Athens,GR), G Trantalis (Athens,GR), C Aggeli (Athens,GR), G Lazaros (Athens,GR), S Sideris (Athens,GR), A Papanikolaou (Athens,GR), E Tsiamis (Athens,GR), D Tousoulis (Athens,GR)

Authors:
A. Michelongona1 , M. Drakopoulou1 , K. Toutouzas1 , S. Brili1 , O. Kaitozis1 , K. Stathogiannis1 , A. Synetos1 , G. Latsios1 , G. Trantalis1 , C. Aggeli1 , G. Lazaros1 , S. Sideris1 , A. Papanikolaou1 , E. Tsiamis1 , D. Tousoulis1 , 1University of Athens Medical School, 1st Department of Cardiology - Athens - Greece ,

Citation:
European Heart Journal ( 2016 ) 37 ( Abstract Supplement ), 748-749

Background: The presence of concomitant mitral regurgitation (MR) is a common issue in patients with severe aortic stenosis and negatively affects patient outcome. Although aortic gradient reduction and left ventricular reverse remodeling can reduce MR after transcatheter aortic valve intervention (TAVI), reported data are contradictory. Our purpose was to investigate the prognostic impact of both pre-procedural and post-procedural MR in patients following TAVI with a self-expandable valve.

Methods: Patients with severe and symptomatic aortic stenosis [effective orifice area (EOA)≤1 cm2] referred for TAVI with a self-expandable valve at our institution were consecutively enrolled. Prospectively collected echocardiographic data before and after TAVI were retrospectively analyzed in all patients. Patients were stratified into two groups according to severity of MR: ≥grade 3 were defined as significant and ≤grade 2 as non-significant. Change in MR severity was assessed by comparison of baseline and 30-day echocardiograms. Primary clinical end-point was all-cause mortality defined according to the criteria proposed by the Valve Academic Research Consortium-2.

Results: We included 157 patients (mean age: 79.9±6.9 years) in the study and in 40 of them, significant MR (≥grade 3) was present prior to TAVI (25.4%). These patients were of higher perioperative risk (logistic EuroScore 28.2±11.0% versus 24.2±9.6%, p=0.02), had higher systolic pulmonary pressure (48.0±13.1mmHg versus 41.4±10.2mmHg, p<0.01) and were more dyspnoeic (New York Heart Association class IV: 30% versus 2.5%, p<0.001). The primary clinical end point occurred in 41 patients (26.1%) during a follow-up period of 26.8±20.7months. Patients with significant pre-procedural MR displayed greater cumulative mortality (37.5% versus 22.2%, p=0.01). Of patients with significant MR only 30% had significant MR at 30 days. Patients in whom MR was improved had lower mortality than those in whom it was worsened (23.9% versus 42.1%, p<0.01). Significant MR was independently associated with mortality [(OR 2.100, B=0.742 (95% CI 0.968–4.556, p<0.05)].

Conclusions: Significant MR is a common finding in patients undergoing TAVI and appears to be independently associated with increased all-cause mortality. However, almost half also present significant improvement in MR severity and exhibit better clinical outcomes. Future work could focus upon identifying factors independently associated with such an improvement.

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