Effect of Transcatheter Aortic Valve Replacement on Concomitant Mitral Regurgitation and Its Impact on Mortality

Guy Witberg; Pablo Codner; Uri Landes; Shmuel Schwartzenberg; Marco Barbanti; Roberto Valvo; Ole De Backer; Joris F Ooms; Fabian Islas; Luis Marroquin; Alexander Sedaghat; Atsushi Sugiura; Giulia Masiero; Paul Werner; Xavier Armario; Claudia Fiorina; Dabit Arzamendi; Sandra Santos-Martinez; Felipe Fernández-Vázquez; Jose A Baz; Klemen Steblovnik; Victor Mauri; Matti Adam; Ilan Merdler; Manuel Hein; Philipp Ruile; Carmelo Grasso; Luca Branca; Rodrigo Estévez-Loureiro; Tomás Benito-González; Ignacio J Amat-Santos; Darren Mylotte; Martin Andreas; Matjaz Bunc; Giuseppe Tarantini; Jan-Malte Sinning; Luis Nombela-Franco; Lars Søndergaard; Nicolas M Van Mieghem; Ariel Finkelstein; Ran Kornowski

doi:10.1016/j.jcin.2021.02.030

Effect of Transcatheter Aortic Valve Replacement on Concomitant Mitral Regurgitation and Its Impact on Mortality

Guy Witberg, Pablo Codner, Uri Landes, Shmuel Schwartzenberg, Marco Barbanti, Roberto Valvo, Ole De Backer, Joris F Ooms, Fabian Islas, Luis Marroquin, Alexander Sedaghat, Atsushi Sugiura, Giulia Masiero, Paul Werner, Xavier Armario, Claudia Fiorina, Dabit Arzamendi, Sandra Santos-Martinez, Felipe Fernández-Vázquez, Jose A BazKlemen Steblovnik, Victor Mauri, Matti Adam, Ilan Merdler, Manuel Hein, Philipp Ruile, Carmelo Grasso, Luca Branca, Rodrigo Estévez-Loureiro, Tomás Benito-González, Ignacio J Amat-Santos, Darren Mylotte, Martin Andreas, Matjaz Bunc, Giuseppe Tarantini, Jan-Malte Sinning, Luis Nombela-Franco, Lars Søndergaard, Nicolas M Van Mieghem, Ariel Finkelstein, Ran Kornowski

Department of Cardiology

Abstract

OBJECTIVES: The purpose of this study was to examine the impact of residual mitral regurgitation (MR) on mortality in patients undergoing transcatheter aortic valve replacement (TAVR).

BACKGROUND: MR is common in patients undergoing TAVR. Data on optimal management of patients with significant MR after TAVR are limited.

METHODS: The registry consisted of 16 TAVR centers (n = 7,303). Outcomes of patients with ≥ moderate versus lesser grade MR after TAVR were compared.

RESULTS: In 1,983 (27.2%) patients, baseline MR grade was ≥ moderate. MR regressed in 874 (44.1%) patients and persisted in 1,109 (55.9%) after TAVR. Four-year mortality was higher for those with MR persistence, but not for those with MR regression after TAVR, compared with nonsignificant baseline MR (43.8% vs. 35.1% vs. 32.4%; hazard ratio [HR]: 1.38; p = 0.008; HR: 1.02; p = 0.383, respectively). New York Heart Association functional class III to IV after TAVR was more common in those with MR persistence vs. regression (14.4% vs. 3.9%; p < 0.001). In a propensity score-matched cohort (91 patients' pairs), with significant residual MR after TAVR who did or did not undergo staged mitral intervention, staged intervention was associated with a better functional class through 1 year of follow-up (82.4% vs. 33.3% New York Heart Association functional class I or II; p < 0.001), and a numerically lower 4-year mortality, which was not statistically significant (64.6% vs. 37.5%; HR: 1.66; p = 0.097).

CONCLUSIONS: Risk stratification based on improvement in MR and symptoms after TAVR can identify patients at increased mortality risk after TAVR. These patients may benefit from a staged transcatheter mitral intervention, but this requires further proof from future studies. (Transcatheter Treatment for Combined Aortic and Mitral Valve Disease. The Aortic+Mitral TRAnsCatheter [AMTRAC] Valve Registry [AMTRAC]; NCT04031274).

Original language	English
Journal	JACC: Cardiovascular Interventions
Volume	14
Issue number	11
Pages (from-to)	1181-1192
Number of pages	12
ISSN	1936-8798
DOIs	https://doi.org/10.1016/j.jcin.2021.02.030
Publication status	Published - 14 Jun 2021

Keywords

Aortic Valve Stenosis/diagnostic imaging
Aortic Valve/diagnostic imaging
Humans
Mitral Valve Insufficiency/diagnostic imaging
Retrospective Studies
Severity of Illness Index
Transcatheter Aortic Valve Replacement/adverse effects
Treatment Outcome

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10.1016/j.jcin.2021.02.030

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Witberg, G., Codner, P., Landes, U., Schwartzenberg, S., Barbanti, M., Valvo, R., De Backer, O., Ooms, J. F., Islas, F., Marroquin, L., Sedaghat, A., Sugiura, A., Masiero, G., Werner, P., Armario, X., Fiorina, C., Arzamendi, D., Santos-Martinez, S., Fernández-Vázquez, F., ... Kornowski, R. (2021). Effect of Transcatheter Aortic Valve Replacement on Concomitant Mitral Regurgitation and Its Impact on Mortality. JACC: Cardiovascular Interventions, 14(11), 1181-1192. https://doi.org/10.1016/j.jcin.2021.02.030

Witberg, G, Codner, P, Landes, U, Schwartzenberg, S, Barbanti, M, Valvo, R, De Backer, O, Ooms, JF, Islas, F, Marroquin, L, Sedaghat, A, Sugiura, A, Masiero, G, Werner, P, Armario, X, Fiorina, C, Arzamendi, D, Santos-Martinez, S, Fernández-Vázquez, F, Baz, JA, Steblovnik, K, Mauri, V, Adam, M, Merdler, I, Hein, M, Ruile, P, Grasso, C, Branca, L, Estévez-Loureiro, R, Benito-González, T, Amat-Santos, IJ, Mylotte, D, Andreas, M, Bunc, M, Tarantini, G, Sinning, J-M, Nombela-Franco, L, Søndergaard, L, Van Mieghem, NM, Finkelstein, A & Kornowski, R 2021, 'Effect of Transcatheter Aortic Valve Replacement on Concomitant Mitral Regurgitation and Its Impact on Mortality', JACC: Cardiovascular Interventions, vol. 14, no. 11, pp. 1181-1192. https://doi.org/10.1016/j.jcin.2021.02.030

@article{f83bdf5683214ab1a5fb2b85236a1a8c,

title = "Effect of Transcatheter Aortic Valve Replacement on Concomitant Mitral Regurgitation and Its Impact on Mortality",

abstract = "OBJECTIVES: The purpose of this study was to examine the impact of residual mitral regurgitation (MR) on mortality in patients undergoing transcatheter aortic valve replacement (TAVR).BACKGROUND: MR is common in patients undergoing TAVR. Data on optimal management of patients with significant MR after TAVR are limited.METHODS: The registry consisted of 16 TAVR centers (n = 7,303). Outcomes of patients with ≥ moderate versus lesser grade MR after TAVR were compared.RESULTS: In 1,983 (27.2%) patients, baseline MR grade was ≥ moderate. MR regressed in 874 (44.1%) patients and persisted in 1,109 (55.9%) after TAVR. Four-year mortality was higher for those with MR persistence, but not for those with MR regression after TAVR, compared with nonsignificant baseline MR (43.8% vs. 35.1% vs. 32.4%; hazard ratio [HR]: 1.38; p = 0.008; HR: 1.02; p = 0.383, respectively). New York Heart Association functional class III to IV after TAVR was more common in those with MR persistence vs. regression (14.4% vs. 3.9%; p < 0.001). In a propensity score-matched cohort (91 patients' pairs), with significant residual MR after TAVR who did or did not undergo staged mitral intervention, staged intervention was associated with a better functional class through 1 year of follow-up (82.4% vs. 33.3% New York Heart Association functional class I or II; p < 0.001), and a numerically lower 4-year mortality, which was not statistically significant (64.6% vs. 37.5%; HR: 1.66; p = 0.097).CONCLUSIONS: Risk stratification based on improvement in MR and symptoms after TAVR can identify patients at increased mortality risk after TAVR. These patients may benefit from a staged transcatheter mitral intervention, but this requires further proof from future studies. (Transcatheter Treatment for Combined Aortic and Mitral Valve Disease. The Aortic+Mitral TRAnsCatheter [AMTRAC] Valve Registry [AMTRAC]; NCT04031274).",

keywords = "Aortic Valve Stenosis/diagnostic imaging, Aortic Valve/diagnostic imaging, Humans, Mitral Valve Insufficiency/diagnostic imaging, Retrospective Studies, Severity of Illness Index, Transcatheter Aortic Valve Replacement/adverse effects, Treatment Outcome",

author = "Guy Witberg and Pablo Codner and Uri Landes and Shmuel Schwartzenberg and Marco Barbanti and Roberto Valvo and {De Backer}, Ole and Ooms, {Joris F} and Fabian Islas and Luis Marroquin and Alexander Sedaghat and Atsushi Sugiura and Giulia Masiero and Paul Werner and Xavier Armario and Claudia Fiorina and Dabit Arzamendi and Sandra Santos-Martinez and Felipe Fern{\'a}ndez-V{\'a}zquez and Baz, {Jose A} and Klemen Steblovnik and Victor Mauri and Matti Adam and Ilan Merdler and Manuel Hein and Philipp Ruile and Carmelo Grasso and Luca Branca and Rodrigo Est{\'e}vez-Loureiro and Tom{\'a}s Benito-Gonz{\'a}lez and Amat-Santos, {Ignacio J} and Darren Mylotte and Martin Andreas and Matjaz Bunc and Giuseppe Tarantini and Jan-Malte Sinning and Luis Nombela-Franco and Lars S{\o}ndergaard and {Van Mieghem}, {Nicolas M} and Ariel Finkelstein and Ran Kornowski",

year = "2021",

month = jun,

day = "14",

doi = "10.1016/j.jcin.2021.02.030",

language = "English",

volume = "14",

pages = "1181--1192",

journal = "JACC: Cardiovascular Interventions",

issn = "1936-8798",

publisher = "Elsevier Inc",

number = "11",

}

TY - JOUR

T1 - Effect of Transcatheter Aortic Valve Replacement on Concomitant Mitral Regurgitation and Its Impact on Mortality

AU - Witberg, Guy

AU - Codner, Pablo

AU - Landes, Uri

AU - Schwartzenberg, Shmuel

AU - Barbanti, Marco

AU - Valvo, Roberto

AU - De Backer, Ole

AU - Ooms, Joris F

AU - Islas, Fabian

AU - Marroquin, Luis

AU - Sedaghat, Alexander

AU - Sugiura, Atsushi

AU - Masiero, Giulia

AU - Werner, Paul

AU - Armario, Xavier

AU - Fiorina, Claudia

AU - Arzamendi, Dabit

AU - Santos-Martinez, Sandra

AU - Fernández-Vázquez, Felipe

AU - Baz, Jose A

AU - Steblovnik, Klemen

AU - Mauri, Victor

AU - Adam, Matti

AU - Merdler, Ilan

AU - Hein, Manuel

AU - Ruile, Philipp

AU - Grasso, Carmelo

AU - Branca, Luca

AU - Estévez-Loureiro, Rodrigo

AU - Benito-González, Tomás

AU - Amat-Santos, Ignacio J

AU - Mylotte, Darren

AU - Andreas, Martin

AU - Bunc, Matjaz

AU - Tarantini, Giuseppe

AU - Sinning, Jan-Malte

AU - Nombela-Franco, Luis

AU - Søndergaard, Lars

AU - Van Mieghem, Nicolas M

AU - Finkelstein, Ariel

AU - Kornowski, Ran

PY - 2021/6/14

Y1 - 2021/6/14

N2 - OBJECTIVES: The purpose of this study was to examine the impact of residual mitral regurgitation (MR) on mortality in patients undergoing transcatheter aortic valve replacement (TAVR).BACKGROUND: MR is common in patients undergoing TAVR. Data on optimal management of patients with significant MR after TAVR are limited.METHODS: The registry consisted of 16 TAVR centers (n = 7,303). Outcomes of patients with ≥ moderate versus lesser grade MR after TAVR were compared.RESULTS: In 1,983 (27.2%) patients, baseline MR grade was ≥ moderate. MR regressed in 874 (44.1%) patients and persisted in 1,109 (55.9%) after TAVR. Four-year mortality was higher for those with MR persistence, but not for those with MR regression after TAVR, compared with nonsignificant baseline MR (43.8% vs. 35.1% vs. 32.4%; hazard ratio [HR]: 1.38; p = 0.008; HR: 1.02; p = 0.383, respectively). New York Heart Association functional class III to IV after TAVR was more common in those with MR persistence vs. regression (14.4% vs. 3.9%; p < 0.001). In a propensity score-matched cohort (91 patients' pairs), with significant residual MR after TAVR who did or did not undergo staged mitral intervention, staged intervention was associated with a better functional class through 1 year of follow-up (82.4% vs. 33.3% New York Heart Association functional class I or II; p < 0.001), and a numerically lower 4-year mortality, which was not statistically significant (64.6% vs. 37.5%; HR: 1.66; p = 0.097).CONCLUSIONS: Risk stratification based on improvement in MR and symptoms after TAVR can identify patients at increased mortality risk after TAVR. These patients may benefit from a staged transcatheter mitral intervention, but this requires further proof from future studies. (Transcatheter Treatment for Combined Aortic and Mitral Valve Disease. The Aortic+Mitral TRAnsCatheter [AMTRAC] Valve Registry [AMTRAC]; NCT04031274).

AB - OBJECTIVES: The purpose of this study was to examine the impact of residual mitral regurgitation (MR) on mortality in patients undergoing transcatheter aortic valve replacement (TAVR).BACKGROUND: MR is common in patients undergoing TAVR. Data on optimal management of patients with significant MR after TAVR are limited.METHODS: The registry consisted of 16 TAVR centers (n = 7,303). Outcomes of patients with ≥ moderate versus lesser grade MR after TAVR were compared.RESULTS: In 1,983 (27.2%) patients, baseline MR grade was ≥ moderate. MR regressed in 874 (44.1%) patients and persisted in 1,109 (55.9%) after TAVR. Four-year mortality was higher for those with MR persistence, but not for those with MR regression after TAVR, compared with nonsignificant baseline MR (43.8% vs. 35.1% vs. 32.4%; hazard ratio [HR]: 1.38; p = 0.008; HR: 1.02; p = 0.383, respectively). New York Heart Association functional class III to IV after TAVR was more common in those with MR persistence vs. regression (14.4% vs. 3.9%; p < 0.001). In a propensity score-matched cohort (91 patients' pairs), with significant residual MR after TAVR who did or did not undergo staged mitral intervention, staged intervention was associated with a better functional class through 1 year of follow-up (82.4% vs. 33.3% New York Heart Association functional class I or II; p < 0.001), and a numerically lower 4-year mortality, which was not statistically significant (64.6% vs. 37.5%; HR: 1.66; p = 0.097).CONCLUSIONS: Risk stratification based on improvement in MR and symptoms after TAVR can identify patients at increased mortality risk after TAVR. These patients may benefit from a staged transcatheter mitral intervention, but this requires further proof from future studies. (Transcatheter Treatment for Combined Aortic and Mitral Valve Disease. The Aortic+Mitral TRAnsCatheter [AMTRAC] Valve Registry [AMTRAC]; NCT04031274).

KW - Aortic Valve Stenosis/diagnostic imaging

KW - Aortic Valve/diagnostic imaging

KW - Humans

KW - Mitral Valve Insufficiency/diagnostic imaging

KW - Retrospective Studies

KW - Severity of Illness Index

KW - Transcatheter Aortic Valve Replacement/adverse effects

KW - Treatment Outcome

UR - http://www.scopus.com/inward/record.url?scp=85106907405&partnerID=8YFLogxK

U2 - 10.1016/j.jcin.2021.02.030

DO - 10.1016/j.jcin.2021.02.030

M3 - Journal article

C2 - 33992550

SN - 1936-8798

VL - 14

SP - 1181

EP - 1192

JO - JACC: Cardiovascular Interventions

JF - JACC: Cardiovascular Interventions

IS - 11

ER -

Effect of Transcatheter Aortic Valve Replacement on Concomitant Mitral Regurgitation and Its Impact on Mortality

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