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. 2023 Sep 5;12(17):e029553.
doi: 10.1161/JAHA.123.029553. Epub 2023 Aug 30.

Prognostic Impact of Mitral Regurgitation Before and After Transcatheter Aortic Valve Replacement in Patients With Severe Low-Flow, Low-Gradient Aortic Stenosis

Germano Junior Ferruzzi  1 , Angelo Silverio  1 , Arturo Giordano  2 , Nicola Corcione  2 , Michele Bellino  1 , Tiziana Attisano  3 , Cesare Baldi  3 , Alberto Morello  2 , Giuseppe Biondi-Zoccai  4   5 , Rodolfo Citro  6   7 , Carmine Vecchione  1   7 , Gennaro Galasso  1
Affiliations

Prognostic Impact of Mitral Regurgitation Before and After Transcatheter Aortic Valve Replacement in Patients With Severe Low-Flow, Low-Gradient Aortic Stenosis

Germano Junior Ferruzzi et al. J Am Heart Assoc. .

Abstract

Background There is little evidence about the prognostic role of mitral regurgitation (MR) in patients with low-flow, low-gradient aortic stenosis undergoing transcatheter aortic valve replacement (TAVR). The aim of this study was to assess the prevalence and outcome implications of MR severity in patients with low-flow, low-gradient aortic stenosis undergoing TAVR, and to evaluate whether MR improvement after TAVR could influence clinical outcome. Methods and Results This study included consecutive patients with low-flow, low-gradient aortic stenosis undergoing TAVR at 2 Italian high-volume centers. The study population was categorized according to the baseline MR severity and to the presence of MR improvement at discharge. The primary outcome was the composite of all-cause death and hospitalization for worsening heart failure up to 1 year. The study included 268 patients; 57 (21%) patients showed MR >2+. Patients with MR >2+ showed a lower 1-year survival free from the primary outcome (P<0.001), all-cause death (P<0.001), and heart failure hospitalization (P<0.001) compared with patients with MR ≤2+. At multivariable analysis, baseline MR >2+ was an independent predictor of the primary outcome (P<0.001). Among patients with baseline MR >2+, MR improvement was reported in 24 (44%) cases after TAVR. The persistence of MR was associated with a significantly reduced survival free from the primary outcome, all-cause death, and heart failure hospitalization up to 1 year. Conclusions In this study, the presence of moderately severe to severe MR in patients with low-flow, low-gradient aortic stenosis undergoing TAVR portends a worse clinical outcome at 1 year. TAVR may improve MR severity in nearly half of the patients, resulting in a potential outcome benefit after discharge.

Keywords: clinical outcome; mitral insufficiency; transcatheter aortic valve implantation.

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Figures

Figure 1
Figure 1. Survival free from the primary outcome (A), all‐cause death (B), and HF hospitalization (C) in patients with MR ≤2+ vs those with MR >2+.
HF indicates heart failure; and MR, mitral regurgitation.
Figure 2
Figure 2. Survival free from the primary outcome (A), all‐cause death (B), and HF hospitalization (C) in patients with MR ≤2+ and in patients with MR >2+ with or without significant improvement after TAVR.
HF indicates heart failure; MR, mitral regurgitation; and TAVR, transcatheter aortic valve replacement.
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