SPC365

Functional Mitral Regurgitation Improvement After Transcatheter Aortic Valve Replacement: A Comprehensive Single-Center Study

Session: Sessão de Posters 54 - Intervenção valvular mitral
Speaker: Ana Margarida Martins

Congress: CPC 2024
Topic: H. Interventional Cardiology and Cardiovascular Surgery
Theme: 25. Interventional Cardiology
Subtheme: 25.3 Non-coronary Cardiac Intervention
Session Type: Cartazes
FP Number: ---
Authors: Ana Margarida Martins; Catarina Oliveira; Ana Beatriz Garcia; João Cravo; Marta Vilela; Rui Plácido; Miguel Nobre de Menezes; Pedro Carrilho Ferreira; Cláudia Jorge; João Silva Marques; Pedro Cardoso; Fausto J. Pinto

<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Introduction</strong>: Moderate to severe mitral regurgitation (MR) is frequently observed in patients (pts) with severe aortic stenosis, contributing to worse prognosis. The potential improvement of MR following transcatheter aortic valve replacement (TAVR) may obviate the need for subsequent mitral interventions.</span></span></span></p>

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<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Aim</strong>: This study aims to assess the change in MR severity after TAVR.</span></span></span></p>

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<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Methods</strong>: Single-center prospective study that enrolled consecutive pts with moderate to severe MR undergoing TAVR. Baseline (pre-TAVR) and 1-year follow-up (FUP) data, including clinical, laboratory, and echocardiographic characteristics, were collected. Functional MR was subcategorized into atrial MR (aMR), characterized by atrial enlargement and mitral annulus dilation, and ventricular MR (vMR), associated with changes in left ventricle (LV) geometry. Descriptive and comparative statistical analyses were employed.</span></span></span></p>

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<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Results</strong>: A total of 114 pts diagnosed with moderate-severe MR before TAVR were included, 106 (93%) had moderate and 8 (7%) severe MR. Functional etiology was identified in 51 pts (76%, n=39 classified as aMR and 24%, n=12 as vMR). </span></span></span></p>

<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">Most pts were female (61.4%) and most frequent comorbidities were hypertension (94.7%), dyslipidemia (76.3%), chronic kidney disease (41.2%), and diabetes (37.7%). Paroxysmal and persistent/permanent atrial fibrillation (AFib) were present in 23.7% and 25.4%, respectively.</span></span></span></p>

<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">Significant improvement in MR severity was observed at the 1-year FUP (p&lt;0.001), but MR remained moderate in 24 pts and severe in 2 (Figure 1). Additionally, there was a significant improvement in LV ejection fraction (LVEF) (p&lt;0.001), tricuspid regurgitation (TR) (p&lt;0.001), a decrease in LV end-diastolic diameter (LVEDD) (p&lt;0.001) and pulmonary artery systolic pressure (sPAP) (p&lt;0.001) (Table I).</span></span></span></p>

<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">When comparing functional etiology at baseline, the most substantial MR improvement was observed in the atrial type (aMR p&lt;0.001 vs vMR p=0.025). In aMR, there was also a notable reduction in TR (p=0.025), sPAP (p=0.041), LVEDD (p=0.015), and an improvement in LVEF (p=0.016). As anticipated, there was no significant improvement in the severity of primary MR after TAVR (p=0.083). </span></span></span></p>

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<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Conclusion:</strong> TAVR positively impacts functional MR, particularly aMR, as well as LV geometry, function, and right heart hemodynamics. Our data support that is advisable to adopt a watchful-waiting approach for functional MR after TAVR, as a mitral intervention may not be necessary during FUP. </span></span></span></p>

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