Impact of <scp>TAVI</scp> on Mitral Regurgitation: A Prospective Echocardiographic Study

Giordana, Francesca; Capriolo, Michele; Frea, Simone; Marra, Walter Grosso; Giorgi, Mauro; Bergamasco, Laura; Omede, P; Sheiban, Imad; D’Amico, Maurizio; Bovolo, Virginia; Salizzoni, Stefano; Torre, Michele La; Marra, Sebastiano; Gaïta, Fiorenzo; Morello, Mara

doi:10.1111/echo.12050

Cited by 48 publications

(33 citation statements)

References 19 publications

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“…15 In our cohort of patients treated with CRS-TAVR, a significant improvement in the MR severity was observed in a high percentage of patients presenting with moderate or severe MR at baseline.…”

Section: Discussionmentioning

confidence: 59%

Interplay Between Mitral Regurgitation and Transcatheter Aortic Valve Replacement With the CoreValve Revalving System

Bedogni¹,

Latib²,

Marco³

et al. 2013

Circulation

126

109

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Background-Little is known of the prognostic significance of mitral regurgitation (MR) on transcatheter aortic valve replacement (TAVR), the impact of TAVR on MR severity, and the variables associated with possible post-TAVR improvement in MR. We evaluated these issues in a multicenter registry of patients undergoing CoreValve Revalving System-TAVR. Methods and Results-Among 1007 consecutive patients, 670 (66.5%), 243 (24.1%), and 94 (9.3%) presented with no/mild, moderate, and severe MR, respectively. At 1 month after TAVR, patients with severe or moderate MR showed comparable mortality rates (odds ratio, 1.1; 95% confidence interval [95% CI], 0.7-1.55; P=0.2), but both were significantly higher compared with patients with mild/no MR (odds ratio, 2.2; 95% CI, 1.78-3.28; P<0.001; and odds ratio, 1.9; 95% CI, 1.1-3.3; P=0.02, respectively). One-year mortality was also similar between patients with severe and those with moderate MR (hazard ratio, 1.4; 95% CI, 0.94-2.4; P=0.06) and still significantly higher compared with patients with mild/no MR (hazard ratio, 1.7; 95% CI, 1.2-3.41; P<0.001; and hazard ratio, 1.4; 95% CI, 1.2-2.2; P=0.03, respectively). Severe pulmonary hypertension, atrial fibrillation, and MR more than mild, but not an improvement of ≥1 grade in MR severity, were independent predictors of mortality at 1 year. At 1 year, an improved MR was observed in 47% and 35% of patients with severe and moderate MR, respectively. The rate of low implantation was consistent across groups with improved, unchanged, or worsened MR. A functional type of MR and the absence of severe pulmonary hypertension and atrial fibrillation independently predicted the improvement in MR severity. Conclusions-Baseline MR greater than mild is associated with higher mortality after CoreValve Revalving System-TAVR. A significant improvement in MR was more likely in patients with functional MR and without severe pulmonary hypertension or atrial fibrillation. The improvement in MR did not independently predict mortality.

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Section: Discussionmentioning

confidence: 59%

Interplay Between Mitral Regurgitation and Transcatheter Aortic Valve Replacement With the CoreValve Revalving System

Bedogni¹,

Latib²,

Marco³

et al. 2013

Circulation

126

109

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“…[1][2][3][4][5][6][7] Particularly after the implantation of the SAPIEN, short-term reduction of MR has been observed in previous reports.…”

mentioning

confidence: 98%

“…[1][2][3][4][5][6][7] Particularly after the implantation of the SAPIEN, short-term reduction of MR has been observed in previous reports.1,3-6 However, there is a paucity of investigation that demonstrates the effect of TAVR on mitral valve anatomy, including mitral leaflet coaptation and identification of the cause of acute MR reduction with or without mitral leaflet tethering. The aims of the present study were to (1) demonstrate the effect of the SAPIEN deployment on mitral valve anatomy, including mitral leaflet coaptation by 3-dimensional (3D) transesophageal echocardiography (TEE); and (2) identify the predictors of MR reduction with or without mitral leaflet tethering after TAVR.…”

mentioning

confidence: 99%

Effect of Transcatheter Aortic Valve Replacement on the Mitral Valve Apparatus and Mitral Regurgitation

Shibayama¹,

Harada²,

Berdejo³

et al. 2014

Circ: Cardiovascular Imaging

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A lthough mitral regurgitation (MR), including functional MR, is present in a large proportion of patients who undergo transcatheter aortic valve replacement (TAVR) for severe aortic stenosis, it is predominantly left untreated.1 Previous articles reported not only the influence of moderate or severe MR on clinical outcomes after TAVR but also the effect of TAVR on MR degree after the implantation of the Edwards SAPIEN or the Medtronic CoreValve. [1][2][3][4][5][6][7] Particularly after the implantation of the SAPIEN, short-term reduction of MR has been observed in previous reports.1,3-6 However, there is a paucity of investigation that demonstrates the effect of TAVR on mitral valve anatomy, including mitral leaflet coaptation and identification of the cause of acute MR reduction with or without mitral leaflet tethering. The aims of the present study were to (1) demonstrate the effect of the SAPIEN deployment on mitral valve anatomy, including mitral leaflet coaptation by 3-dimensional (3D) transesophageal echocardiography (TEE); and (2) identify the predictors of MR reduction with or without mitral leaflet tethering after TAVR. Clinical Perspective on p 351 Methods Study PopulationWe studied 332 consecutive patients with aortic stenosis who underwent TAVR and had intraprocedural 3D TEE from December 2010 to January 2013 in our institute. In total, 233 patients were excluded because pre-and postprocedural 3D TEE data, including mitral valve apparatus, were not available. We also excluded 9 patients with surgical history of mitral valve replacement, mitral valve repair, or aortic valve replacement. Finally, we included 90 patients in this study. Data were retrieved from our computerized database. This study was approved by the institutional review board. Comprehensive Transthoracic EchocardiographyComprehensive two-dimensional and Doppler transthoracic echocardiography (TTE) was performed routinely at our institute on all patients at baseline and 1 day after TAVR. The iE33 ultrasound system (Philips Medical Systems, Andover, MA) equipped with S5-1 phased array transducer (Philips Medical Systems) was used. In accordance with the American College of Cardiology/American Heart Association guideline, MR severity was graded as none, trivial, mild, moderate, or severe by primarily MR jet area, and, if necessary, other echocardiographic methods, including vena contracta, proximal isovelocity Background-The effect of transcatheter aortic valve replacement (TAVR) on the mitral valve apparatus and factors influencing the reduction of mitral regurgitation with or without mitral leaflet tethering after TAVR are poorly understood. The present 3-dimensional (3D) transesophageal echocardiography study aimed to elucidate early changes further in the structure and function of the mitral valve apparatus after TAVR. Methods and Results-We analyzed 90 patients (nontenting group, 56 patients and tenting group, 34 patients) who underwent TAVR using the Edwards SAPIEN and had intraprocedural 3D transesophageal echocardiography evaluat...

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“…These changes have a beneficial effect on mitral valve performance, and several reports have shown a decrease in the severity of the mitral regurgitation following TAVR. [114][115][116][117][118] However, a single study demonstrated that a deeply embedded prosthesis is likely to interfere with the anterior mitral valve leaflet, induce mitral regurgitation, or even cause mitral stenosis. 119 Mitral valve dysfunction after TAVR can also be attributable to the injury of the mitral valve apparatus by the guidewire used to deliver the device.…”

Section: Other Complicationsmentioning

confidence: 99%

Evolution of Transcatheter Aortic Valve Replacement

Bourantas

Serruys

2014

Circulation Research

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Impact of TAVI on Mitral Regurgitation: A Prospective Echocardiographic Study

Abstract: This multiparametric echocardiographic evaluation showed that MR improved significantly after TAVI and that this result may be related to the type of valve implanted.

Cited by 48 publications

References 19 publications

Interplay Between Mitral Regurgitation and Transcatheter Aortic Valve Replacement With the CoreValve Revalving System

Interplay Between Mitral Regurgitation and Transcatheter Aortic Valve Replacement With the CoreValve Revalving System

Effect of Transcatheter Aortic Valve Replacement on the Mitral Valve Apparatus and Mitral Regurgitation

Evolution of Transcatheter Aortic Valve Replacement

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