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Transcatheter aortic valve replacement in patients with aortic stenosis and mitral regurgitation

Session Poster Session 2

Speaker Manuel Munoz-Garcia

Congress : Heart Failure 2019

  • Topic : valvular, myocardial, pericardial, pulmonary, congenital heart disease
  • Sub-topic : Valvular Heart Disease - Epidemiology, Prognosis, Outcome
  • Session type : Poster Session
  • FP Number : P1128

Authors : M Munoz-Garcia (Malaga,ES), E Munoz-Garcia (Malaga,ES), A J Munoz Garcia (Malaga,ES), F Carrasco-Chinchilla (Malaga,ES), AJ Dominguez-Franco (Malaga,ES), L Morcillo-Hidalgo (Malaga,ES), JM Garcia-Pinilla (Malaga,ES), JH Alonso-Briales (Malaga,ES), JM Hernandez-Garcia (Malaga,ES), MF Jimenez-Navarro (Malaga,ES)

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Authors:
M Munoz-Garcia1 , E Munoz-Garcia1 , A J Munoz Garcia1 , F Carrasco-Chinchilla1 , AJ Dominguez-Franco1 , L Morcillo-Hidalgo1 , JM Garcia-Pinilla1 , JH Alonso-Briales1 , JM Hernandez-Garcia1 , MF Jimenez-Navarro1 , 1University Hospital Virgen de la Victoria, Department of Cardiology - Malaga - Spain ,

Citation:

Background: Many patients undergoing transcatheter aortic valve replacement (TAVR) for aortic stenosis also have significant mitral regurgitation (MR). We sought to understand the association of concomitant MR with TAVR clinical outcomes, as well changes in MR after TAVR.

Methods. Patients who underwent TAVR at our center,between april  2008 to  December 2017, were studied, with longer term clinical outcomes

Results: Of 667patients, 92 (13.8%) had moderate MR, and 47 (2.1%) had severe MR. At 3.2±2.2 years, mortality was 39.4%, 46.1%, 39.1%, 57.6% and 50%  and heart failure (HF) rehospitalization was 7%, 7.9%, 17.6%, 21.9% and 46.2% (p < 0.001) in the no, mild, moderate, moderate-severe and severe MR patients, respectively.  After procedure, 64 patients (9.9%)  had moderate MR and 24 patients (3.7%) had severe MR. At follow-up, the mortality  was 35.9%, 46.5%, 48.4%, 52.9% and 85.7%, p <0.001 and HF rehospitalizations 9.1%, 5.5%, 23.4%, 35.3% and 40 % in the no, mild, moderate, moderate-severe and severe MR patients, respectively. MR improved early after TAVI grade in 88 patients (13.2%). Baseline MR is not associated with mortality (HR= 0.883 [95 CI 0.708-1.102], p= 0.114), but MR post-TAVI  was associagted with increase risk of mortality (HR= 1.539 [95 CI 1.187-1.996], p= 0.001.  In 7 patients with persistent MR received percutaneous mitral repair with MitraClip.

Conclusions: In our series, Moderate or severe MR after TAVI is associated with increased mortality or HF rehospitalization, this increased risk may be atrributable to the minority of patients whose MR does not improve and could benefit from percutaneous mitral procedures (Mitraclip).

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