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Impact of residual significant mitral regurgitation in TAVR patients
Session:
Comunicações Orais (Sessão 21) - Intervenção Cardíaca Coronária e Estrutural 3 - Vários Tópicos
Speaker:
Gualter Santos Silva
Congress:
CPC 2022
Topic:
H. Interventional Cardiology and Cardiovascular Surgery
Theme:
25. Interventional Cardiology
Subtheme:
25.3 Non-coronary Cardiac Intervention
Session Type:
Comunicações Orais
FP Number:
---
Authors:
Gualter Santos Silva; Mariana Silva; Pedro Queirós; Mariana Brandão; Diogo Ferreira; Cláudio Guerreiro; Gustavo Pires-Morais; Lino Santos; Bruno Melica; Alberto Rodrigues; Pedro Braga; Ricardo Fontes-Carvalho
Abstract
<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Background:</strong> Significant mitral regurgitation (MR) is commonly encountered in patients with severe aortic stenosis undergoing transcatheter aortic valve replacement (TAVR). A decrease in MR severity after aortic valve replacement may be seen as a result of reverse left ventricle remodelling, including a reduction in LV end-diastolic volume and a decrease in mitral tethering forces. However, the impact of MR severity improvement in outcomes of patients undergoing TAVR has not been well established.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Objective:</strong> The purpose of this study was to evaluate the improvement of significant MR and the impact of residual MR on mortality in patients undergoing TAVR.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Methods:</strong> Retrospective analysis of patients who underwent TAVR in a single centre between August 2007 and September 2020 and performed an echocardiogram before and at least 3 months after the procedure. MR severity was graded as no/mild (0/1), moderate (2), moderate-severe (3) or severe (4). Improvement in MR severity was defined as a decrease in at least one grade. Patients were stratified by existence of improvement in MR severity after TAVR (yes/no). The primary endpoint was all-cause mortality.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Results:</strong> A total of 684 patients (mean age 79.7 ± 7.6 years, 52% woman) were enrolled and 103 (15.1%) had significant MR (grade ≥3). Overall, there was an improvement in MR severity in 179 (26.2%) patients. In the group of preoperative significant MR, MR regressed in 66 (64.1%) patients and persisted in 37 (35.9%) after TAVR. There is no difference in baseline characteristics between these two groups. One-year mortality was significantly lower in those with MR regression (1.5% vs 17.1%, p=0.003). </span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Conclusion:</strong> Concomitant significant baseline MR is relatively common in TAVR patients. In two-thirds of these patients, the degree of MR improves after the procedure with an associated positive impact on clinical outcomes. Risk stratification based on the improvement of MR after TAVR can help to identify patients at higher risk of mortality, who may need closer surveillance and possible transcatheter mitral valve intervention.</span></span></p>
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