Change in mitral regurgitation severity impacts survival after transcatheter aortic valve replacement

Research output: Contribution to journalArticle

Abstract

Background: The impact of a change in mitral regurgitation (MR) following TAVR is unknown. We studied the impact of baseline MR and early post-procedural change in MR on survival following TAVR. Methods: The SWEDEHEART registry included all TAVRs performed in Sweden. Patients were dichotomized into no/mild and moderate/severe MR groups. Vital status, echocardiographic data at baseline and within 7 days after TAVR were analyzed. Results: 1712 patients were included. 1404 (82%) had no/mild MR and 308 (18%) had moderate/severe MR. Baseline moderate/severe MR conferred a higher mortality rate at 5-year follow-up (adjusted HR 1.29, CI 1.01–1.65, p = 0.04). Using persistent ≤mild MR as the reference, when moderate/severe MR persisted or if MR worsened from ≤mild at baseline to moderate/severe after TAVR, higher 5-year mortality rates were seen (adjusted HR 1.66, CI 1.17–2.34, p = 0.04; adjusted HR 1.97, CI 1.29–3.00, p = 0.002, respectively). If baseline moderate/severe MR improved to ≤mild after TAVR no excess mortality was seen (HR 1.09, CI 0.75–1.58, p = 0.67). Paravalvular aortic regurgitation (PVL) was inversely associated with MR improvement after TAVR (OR 0.4, 95%: CI 0.17–0.94; p = 0.034). Atrial fibrillation (OR 2.1, 95% CI: 1.27–3.39, p = 0.004), self-expanding valve (OR 3.8, 95% CI: 2.08–7.14, p < 0.0001), and PVL (4.3, 95% CI 2.32–7.78. p < 0.0001) were associated with MR worsening. Conclusions: Moderate/severe baseline MR in patients undergoing TAVR is associated with a mortality increase during 5 years of follow-up. This risk is offset if MR improves to ≤mild, whereas worsening of MR after TAVR is associated with a 2-fold mortality increase.

Details

Authors
  • Kari Feldt
  • Rodney De Palma
  • Henrik Bjursten
  • Petur Petursson
  • Niels Erik Nielsen
  • Thomas Kellerth
  • Anders Jönsson
  • Johan Nilsson
  • Andreas Rück
  • Magnus Settergren
Organisations
External organisations
  • Karolinska University Hospital
  • Karolinska Institutet
  • Skåne University Hospital
  • Sahlgrenska University Hospital
  • Linköping University Hospital
  • Örebro University Hospital
  • Uppsala University Hospital
  • Buckinghamshire Healthcare NHS Trust
  • University of Gothenburg
  • Norrland University Hospital
Research areas and keywords

Subject classification (UKÄ) – MANDATORY

  • Cardiac and Cardiovascular Systems
  • Surgery

Keywords

  • Long-term, Mitral regurgitation, Prognosis, Survival, TAVR
Original languageEnglish
Pages (from-to)32-36
Number of pages5
JournalInternational Journal of Cardiology
Volume294
Publication statusPublished - 2019
Publication categoryResearch
Peer-reviewedYes