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2. Transcatheter Treatment of Residual Significant Mitral Regurgitation Following TAVR: A Multicenter Registry

Author

Witberg, G, Codner, P, Landes, U, Brabanti, M, Valvo, R, De Backer, O, Ooms, JF, Sievert, K, El Sabbagh, A, Jimenez-Quevedo, P, Brennan, PF, Sedaghat, A, Masiero, G, Werner, P, Overtchouk, P, Watanabe, Y, Montorfano, M, Bijjam, VR, Hein, M, Fiorina, C, Arzamendi, D, Rodriguez-Gabella, T, Fernandez-Vazquez, F, Baz, JA, Laperche, C, Grasso, C, Branca, L, Estevez-Loureiro, R, Benito-Gonzalez, T, Santos, IJA, Ruile, P, Mylotte, D, Buzzatti, N, Piazza, N, Andreas, M, Tarantini, G, Sinning, JM, Spence, MS, Nombela-Franco, L, Guerrero, M, Sievert, H, Sondergaard, L, Van Mieghem, NM, Tchetche, D, Webb, JG, Kornowski, R, and Cardiology

Subjects
Aged, 80 and over, Mitral Valve Insufficiency, aortic stenosis, Aortic Valve Stenosis, TAVR, Severity of Illness Index, mitral regurgitation, TMVR/r, Transcatheter Aortic Valve Replacement, Treatment Outcome, Aortic Valve, Humans, Registries, Aged
Abstract

OBJECTIVES The aim of this study was to describe baseline characteristics, and periprocedural and mid-term outcomes of patients undergoing transcatheter mitral valve interventions post-transcatheter aortic valve replacement (TAVR) and examine their clinical benefit. BACKGROUND The optimal management of residual mitral regurgitation (MR) post-TAVR is challenging. METHODS This was an international registry of 23 TAVR centers. RESULTS In total, 106 of 24,178 patients (0.43%) underwent mitral interventions post-TAVR (100 staged, 6 concomitant), most commonly percutaneous edge-to-edge mitral valve repair (PMVR). The median interval post-TAVR was 164 days. Mean age was 79.5 +/- 7.2 years, MR was >moderate in 97.2%, technical success was 99.1%, and 30-day device success rate was 88.7%. There were 18 periprocedural complications (16.9%) including 4 deaths. During a median follow-up of 464 days, the cumulative risk for 3-year mortality was 29.0%. MR grade and New York Heart Association (NYHA) functional class improved dramatically; at 1 year, MR was moderate or less in 90.9% of patients (mild or less in 69.1%), and 85.9% of patients were in NYHA functional class I/II. Staged PMVR was associated with lower mortality versus medical treatment (57.5% vs. 30.8%) in a propensity-matched cohort (n = 156), but this was not statistically significant (hazard ratio: 1.75; p = 0.05). CONCLUSIONS For patients who continue to have significant MR, remain symptomatic post-TAVR, and are anatomically suitable for transcatheter interventions, these interventions are feasible, safe, and associated with significant improvement in MR grade and NYHA functional class. These results apply mainly to PMVR. A staged PMVR strategy was associated with markedly lower mortality, but this was not statistically significant. (Transcatheter Treatment for Combined Aortic and Mitral Valve Disease. The Aortic+Mitral TRAnsCatheter Valve Registry [AMTRAC]; NCT04031274) (C) 2020 by the American College of Cardiology Foundation.

Published
2020

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