Transcatheter aortic valve replacement: outcomes of patients with moderate or severe mitral regurgitation

J Am Coll Cardiol. 2012 Jun 5;59(23):2068-74. doi: 10.1016/j.jacc.2012.02.020. Epub 2012 Apr 4.


Objectives: The aim of this study was to evaluate the impact of mitral regurgitation (MR) on outcomes after transcatheter aortic valve replacement (TAVR) and the impact of TAVR on MR.

Background: Little is known of the influence of MR on outcomes after TAVR.

Methods: The outcomes of patients with mild or less (n = 319), moderate (n = 89), and severe (n = 43) MR were evaluated after TAVR at 2 Canadian centers.

Results: Patients with moderate or severe MR had a higher mortality rate than those with mild or less MR during the 30 days after TAVR (adjusted hazard ratio: 2.10; 95% confidence interval: 1.12 to 3.94; p = 0.02). However, the mortality rates after 30 days were similar (adjusted hazard ratio: 0.82; 95% confidence interval: 0.50 to 1.34; p = 0.42). One year after TAVR, moderate MR had improved in 58%, remained moderate in 17%, and worsened to severe in 1%, and 24% of patients had died. Severe MR had improved in 49% and remained severe in 16%, and 35% of patients had died. Multivariate predictors of improved MR at 1 year (vs. unchanged MR, worse MR, or death) were a mean transaortic gradient ≥ 40 mm Hg, functional (as opposed to structural) MR, the absence of pulmonary hypertension, and the absence of atrial fibrillation.

Conclusions: Moderate or severe MR in patients undergoing TAVR is associated with a higher early, but not late, mortality rate. At 1-year follow-up, MR was improved in 55% of patients with moderate or severe MR at baseline. Improvement was more likely in patients with high transaortic gradients, with functional MR, without pulmonary hypertension and without atrial fibrillation.

Publication types

  • Comparative Study
  • Multicenter Study

MeSH terms

  • Aged
  • Aged, 80 and over
  • Aortic Valve Stenosis / complications
  • Aortic Valve Stenosis / diagnostic imaging
  • Aortic Valve Stenosis / mortality*
  • Aortic Valve Stenosis / therapy*
  • Bioprosthesis
  • British Columbia
  • Cardiac Catheterization / methods
  • Cohort Studies
  • Echocardiography, Doppler
  • Female
  • Follow-Up Studies
  • Heart Valve Prosthesis
  • Heart Valve Prosthesis Implantation / methods*
  • Heart Valve Prosthesis Implantation / mortality*
  • Humans
  • Kaplan-Meier Estimate
  • Male
  • Minimally Invasive Surgical Procedures / methods
  • Minimally Invasive Surgical Procedures / mortality
  • Mitral Valve Insufficiency / complications
  • Mitral Valve Insufficiency / diagnostic imaging
  • Mitral Valve Insufficiency / mortality*
  • Mitral Valve Insufficiency / therapy*
  • Odds Ratio
  • Predictive Value of Tests
  • Proportional Hazards Models
  • Prosthesis Failure
  • Retrospective Studies
  • Risk Assessment
  • Severity of Illness Index
  • Statistics, Nonparametric
  • Survival Analysis
  • Time Factors
  • Treatment Outcome