TCT-92 Does mitral regurgitation impact the outcome of TAVI procedures? Insights from the FRANCE2 Registry

Abstract

complication in Balloon-expendable (BE) and Self-expendable (SE) TAVI procedures remain unclear. Methods: 2,769 patients consecutive with a successful procedure and a predischarge transthoracic echocardiography (TTE) were enrolled in 33 centers. Mean follow-up was 302Ϯ164 days. Results: Mean age was 83Ϯ7 years; 49% were female and logistic EuroSCORE was 21.5Ϯ13.8. BE and SE devices was implanted in 67.6% (nϭ1872) and 32.4% (nϭ897), respectively. Approaches were femoral (75.4%) or non femoral: subclavian (5.6%), transapical (17.2%) or transaortic (1.8%). A perivalvular ARՆ2 was observed in 14.9%. Its occurrence was 2 fold higher in SE (19.8%) than in BE-TAVI procedures (12.2%, pϭ0.0001). This remained significant in multivariate analysis (adjusted HRϭ2.01, pϭ0.0001). A perivalvular ARՆ2 was associated with a mortality at 1 year (24.2%) twice higher than in patients without AR (11.9%) (pϭ0.0001). This figure was similar for BE (27.1% vs 12.0%) and SE-TAVI (20.5% vs 11.8%) procedures. By multivariate analysis, a perivalvular ARՆ2 was the strongest predictor of 1 year mortality (ad. ]; pϭ0.0001). This figure was similar for BE (ad. HRϭ2.68) and SE-TAVI (ad. HRϭ2.10) procedures. For BE-TAVI procedures, male gender (ad. HRϭ1.66, pϭ0.001), a device diameter/aortic annulus diameter Ratio Ͻ1.1 (ad. HRϭ1.83, pϭ0.0001) and a femoral approach (ad. HRϭ1.70, pϭ0.006) were the 3 major independent predictors of ARՆ2. For SE-TAVI procedures, male gender (ad. HRϭ1.61, pϭ0.01) and a femoral approach (ad.HRϭ2.1, pϭ0.008) were 2 independent predictors of ARՆ2. Importantly, device diameter/aortic annulus diameter Ratio was not a predictor of AR for SE-TAVI procedures. Conclusions: Post-procedural perivalvular ARՆ2 was observed in 15% of successful TAVI procedures. Its occurrence doubled the 1-year mortality rate and was the strongest and independent predictor of 1-year mortality for both BE and SE-TAVI procedures. Analysis of predictors of AR suggests that device-type and procedural characteristics may impact the occurrence of AR. Background:The presence of mitral regurgitation (MR) is an independent predictor of mortality after conventional aortic valve replacement for aortic stenosis. The predictive value of pre-procedural MR on clinical outcome after TAVI is unknown. Methods: 3,195 consecutive patients were enrolled in 33 centres. MR was graded according to pre-procedural transthoracic echocardiography (TTE) as none/trivial(ϭ0), mild(ϭ1), moderate(ϭ2), moderate-to-severe(ϭ3), or severe(ϭ4). The mean age was 82Ϯ7 years; 49% were female and mean logistic EuroSCORE was 21.9Ϯ14.3. Balloon (BE) and self-expendable (SE) devices were implanted in 66.9% and 33.1% of patients, respectively. Approaches were transarterial (transfemoral: 74.6%; subclavian: 5.8%), transapical (17.8%), and transaortic (1.8%). Results: Pre-procedural TTE showed no MR in 32% of cases, a grade 1 MR in 46% of cases, a grade 2 MR in 20% of cases and a grade 3-4 in 2% of cases. Procedural success rate was 96.9%. Actuarial 1 year mortality was 19.5%. By univariate anal...

Meta-Analysis of the Impact of Mitral Regurgitation on Outcomes After Transcatheter Aortic Valve Implantation

“…The final analysis was performed on a total of 8 studies comprising 8927 patients, meeting all inclusion and no exclusion criteria. The studies included 7 non-randomized registries [9][10][11][12]14,18,19 and 1 study reporting combined outcomes from the randomized controlled PARTNER trials (Cohorts A and B) 8 Study outcomes are summarized in Table 3. The presence of moderate-severe MR at baseline was associated with increased all-cause mortality at 30-days (RR 1.35, 95% CI 1.14-1.59, p = 0.0003, I 2 = 0%, chi 2 = 6.02) and 1 year (RR 1.24, 95% CI 1.13-1.37, p < 0.0001, I 2 = 0%, chi 2 = 5.15) ( Figure 2).…”

“…The presence of moderate-severe MR was associated with increased 30-day rehospitalization rates (RR 1.75, 95% CI 1.02-2.99, p = 0.04, I 2 = 0%, chi 2 = 0.60); the Mortality at one year was analyzed according to the type of transcatheter heart valve implanted. One study used the CoreValve device 10 , 4 studies used the Edwards valve 8,9,12,18 and 3 studies used both valve types 11,14,19 . Consistent with the increased 1-year mortality overall (as reported previously), both CoreValve (RR 1.42, 95% CI 1.08-1.86, p = 0.01, heterogeneity not applicable) and Edwards valve studies (RR 1.21, 95% CI 1.02-1.42, p = 0.02, I 2 = 14%, chi 2 = 3.48) had a statistically significant increase in 1 year mortality with moderate-severe MR ( Figure 4).…”

“…Moderate-severe mitral regurgitation (MR) is present in 20-30% of patients undergoing TAVI and constitutes a significant co-existing valvular heart disease burden [8][9][10][11][12][13][14] . Before TAVI therapy is extended to patients with mixed valvular heart disease (severe AS and significant MR) who are surgical candidates, the impact of co-existing MR on TAVI outcomes must be assessed systematically.…”

“…In addition to the data on 30-day and 1-year outcomes, other variables abstracted included, but were not limited to, the following: first author and senior author; year of publication; country of study; study size; mean age, Society of Thoracic Surgeons (STS) score and EuroScore; type of transcatheter heart valve and approach used; duration of follow-up; study definitions, inclusion and exclusion criteria; and other primary and secondary outcomes of each study. The first author and senior author of included studies were contacted to obtain additional data to evaluate the impact of the etiology of MR, individual grades of MR and residual MR on outcomes after TAVI; of these, the authors of 7 8,[10][11][12]14,18,19 out of 8 studies provided the relevant information to perform these additional analyses.…”

Concomitant significant mitral regurgitation in patients with aortic valve stenosis undergoing valve replacement: Practical indications

“…when patients undergoing taVr are taken into account, the situation in similar, with some study showing an increased mortality associated with significant MR [11][12][13][14][15][16][17] and others in which this association did not reach the statistical significance [18][19][20][21] . another meta-analysis, recently published, showed that patients with moderate-to-severe Mr undergoing taVr have a significantly increased mortality compared to no/mild MR at 30 days(es -0.18; 95% CI: -0.31 to -0.04), 1 year (es -0.22; 95% CI -0.36 to -0.08) and 2 years(es -0.15; CI: -0.27 to -0.02)after taVr 22 .…”