Mitral valve regurgitation in patients undergoing TAVI: Impact of severity and etiology on clinical outcome

Muratori, Manuela; Fusini, Laura; Tamborini, Gloria; Ali, Sarah; Gripari, Paola; Fabbiocchi, Franco; Salvi, Luca; Trabattoni, Piero; Roberto, Maurizio; Agrifoglio, Marco; Alamanni, Francesco; Bartorelli, Antonio L.; Pepi, Mauro

doi:10.1016/j.ijcard.2019.07.060

Cited by 29 publications

(27 citation statements)

References 27 publications

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“…In this small single-center study, we demonstrated that about 40% of patients with moderate to severe MR have at least one grade improvement in the severity of the MR 3 months after TAVI. This is compatible with data in previously published studies [4][5][6][7][8]. We were unable to find any meaningful predictor of MR severity improvement among very broad range of clinical, echocardiographic and laboratory parameters.…”

Section: Discussionsupporting

confidence: 91%

“…Mitral regurgitation (MR) is frequently associated with severe aortic stenosis (AS). Previous studies have demonstrated that about one-third of patients undergoing transcatheter aortic valve implantation (TAVI) for the treatment of severe AS, have at least moderate MR (MR grade ≥ 2) [1][2][3][4]. Significant MR is associated with less favorable prognosis after TAVI, including higher early and late mortality rate [4][5][6][7][8].…”

Section: Introductionmentioning

confidence: 99%

“…Previous studies have demonstrated that about one-third of patients undergoing transcatheter aortic valve implantation (TAVI) for the treatment of severe AS, have at least moderate MR (MR grade ≥ 2) [1][2][3][4]. Significant MR is associated with less favorable prognosis after TAVI, including higher early and late mortality rate [4][5][6][7][8]. Several previous studies had conflicted results about incidence of MR improvement in patients with severe AS after TAVI procedure, with numbers ranging from 30% to 70% [4][5][6][7][8].…”

Section: Introductionmentioning

confidence: 99%

“…Significant MR is associated with less favorable prognosis after TAVI, including higher early and late mortality rate [4][5][6][7][8]. Several previous studies had conflicted results about incidence of MR improvement in patients with severe AS after TAVI procedure, with numbers ranging from 30% to 70% [4][5][6][7][8]. Moreover, the predictors of MR improvement after TAVI are largely unknown.…”

Section: Introductionmentioning

confidence: 99%

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Predictors of Mitral Regurgitation Severity Improvement in Patients With Severe Aortic Stenosis Undergoing Transcatheter Aortic Valve Implantation

et al. 2021

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Background: Mitral regurgitation (MR) is frequently associated with severe aortic stenosis (AS). Significant MR is associated with less favorable prognosis after transcatheter aortic valve implantation (TAVI), including higher early and late mortality rate. The severity of MR is improved in about half of patients undergoing TAVI. However, the predictors of MR improvement after TAVI are unknown. We sought to investigate whether several demographic, clinical, echocardiographic and laboratory parameters and procedure characteristics are predictive of MR severity improvement after TAVI procedure.Methods: A total of 309 consecutive patients with severe symptomatic AS underwent TAVI procedure in our center from July 1, 2015 till December 31, 2019. The 85 patients had concomitant significant (grade 2 or 3) MR. We performed logistic regression analysis of age, sex, atrial fibrillation, left ventricular ejection fraction, end diastolic diameter, end systolic diameter, left atrial diameter, left atrial area, MR etiology (functional vs. degenerative), CHA2DS2-VASc score, pre-procedure B-type natriuretic peptide (BNP) levels and type of TAVI bioprosthesis as possible predictors of post-TAVI improvement of severity of MR. Results:The 35 patients have at least one grade reduction in the severity of MR in follow-up echo. None of the analyzed parameters were predicting of the MR severity improvement. Conclusions:In this small single-center cohort study, we were unable to find any feasible demographic, clinical, echocardiographic or laboratory predictors of MR improvement after TAVI. There was no correlation between etiology of MR or type of TAVI bioprosthesis used and MR improvement.

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Section: Discussionsupporting

confidence: 91%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Predictors of Mitral Regurgitation Severity Improvement in Patients With Severe Aortic Stenosis Undergoing Transcatheter Aortic Valve Implantation

et al. 2021

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“…However, these findings are mainly hypothesis generating, and effects of observed hemodynamic changes may be influenced by the high-risk profile patient population with according comorbidities/confounders. Different to concomitant significant MR in patients undergoing TAVI, in which a reduction in MR severity can be expected in a large proportion of patients with functional MR, 25 patients with significant MS present a pronounced different risk profile. Due to the described severely impaired outcomes in patients with moderate and severe MS, other therapy strategies shall be commented.…”

Section: Main Findingsmentioning

confidence: 83%

TAVI in Patients with Mitral Annular Calcification and/or Mitral Stenosis

Schaefer¹,

Sarwari²,

Schofer³

et al. 2020

Thorac Cardiovasc Surg

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Background We herein aimed for analysis of influence of mitral annular calcification (MAC) and mitral stenosis (MS) on outcomes in transcatheter aortic valve implantation (TAVI). Methods Between 11/2009 and 06/2017, 1,058 patients underwent TAVI in the presence of concomitant MAC or MS at our center. Subgroups were built and multivariate logistic regression, COX regression, Kaplan–Meier survival analyses, and receiver operating characteristics method were performed. Results Thirty-day mortality was 7.5% (79/1,058) with highest mortality in patients severe MS (MAC: 3.4% vs. mild MS: 5.9% vs. moderate MS: 15.0% vs. severe MS: 72.7%; p < 0.001). Moderate-to-severe MS (odds ratio [OR]: 7.75, confidence interval [CI]: 3.94–16.26, p < 0.001), impaired left ventricular ejection fraction (OR: 1.38, CI: 1.10–1.72, p < 0.01), and coronary artery disease (OR: 1.36, CI: 1.11–1.67, p < 0.01) were predictive of 30-day survival. Left ventricular systolic/end-diastolic pressure drop of <59.5 mm Hg / <19.5 mm Hg was associated with increased mortality. Conclusions TAVI in the presence of MAC and mild MS is associated with acceptable acute outcomes but should be considered high-risk procedures in patients with moderate and especially those with severe MS. Our results suggest adverse hemodynamics after TAVI with concomitant MS, which may be caused by underfilling of the left ventricle leading to low-cardiac output.

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Determinants and treatments of heart failure after transcatheter aortic valve implantation: moving up a notch

et al. 2023

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Transcatheter aortic valve implantation (TAVI) has become an alternative to surgical aortic valve replacement for patients with symptomatic severe aortic stenosis in elderly and comorbid population. Significant improvement in heart function has been observed in patients undergoing TAVI, but numerous patients are readmitted to hospital for heart failure (HF). Moreover, repeat HF hospitalization is strongly associated with an adverse prognosis and increases the financial burden of health care. Although studies have identified pre-existing and post-procedural factors that contribute to HF hospitalization after TAVI, there is a paucity of data regarding optimal post-procedural pharmacological treatments. This review aims to provide an overview of the current understanding of mechanisms, determinants, and potential treatments of HF following TAVI. We first review the pathophysiology of left ventricular (LV) remodelling, coronary microcirculation disorder, and endothelial dysfunction in patients with aortic stenosis and then examine the impact of TAVI on these conditions. We then present evidence of various factors and complications that may interplay with LV remodelling and contribute to HF events after TAVI. Next, we describe the triggers and predictors of early and late HF rehospitalizations following TAVI. Lastly, we discuss the potential of conventional pharmacological treatments, including renin-angiotensin blockers, beta-blockers, and diuretics in TAVI patients. The paper explores the potential of newer drugs, including sodium-glucose co-transporter 2 inhibitors, anti-inflammatory drugs, and ion supplementation. Comprehensive knowledge in this field may aid in recognizing successful existing therapies, developing effective new treatments, and establishing dedicated patient care strategies during follow-up after TAVI.

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Mitral valve regurgitation in patients undergoing TAVI: Impact of severity and etiology on clinical outcome

Cited by 29 publications

References 27 publications

Predictors of Mitral Regurgitation Severity Improvement in Patients With Severe Aortic Stenosis Undergoing Transcatheter Aortic Valve Implantation

Predictors of Mitral Regurgitation Severity Improvement in Patients With Severe Aortic Stenosis Undergoing Transcatheter Aortic Valve Implantation

TAVI in Patients with Mitral Annular Calcification and/or Mitral Stenosis

Determinants and treatments of heart failure after transcatheter aortic valve implantation: moving up a notch

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