In patients undergoing surgical aortic valve replacement (SAVR) for severe aortic stenosis (AS), guidelines generally recommend mitral valve repair or replacement for patients with severe mitral regurgitation (MR), whereas the decision to intervene in moderate MR is less certain.
1Despite the fact that these indications to intervene on the mitral valve were derived mainly from observational data and expert opinion, it is felt that the 2-fold increase in surgical risk of a double valve intervention over a single AVR is justified when severe MR is present but debatable when moderate MR is present.
- Nishimura R.A.
- Otto C.M.
- Bonow R.O.
- et al.
2014 AHA/ACC guideline for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines.
Circulation. 2014; 129: e521-643
2With the emergence of transcatheter aortic valve replacement (TAVR) as a viable and often preferable treatment strategy for patients with AS,
- Iung B.
- Baron G.
- Butchart E.G.
- et al.
A prospective survey of patients with valvular heart disease in Europe: the Euro Heart Survey on Valvular Heart Disease.
Eur Heart J. 2003; 24: 1231-1243
3there is a growing need to reevaluate the role, timing, and mode of mitral valve intervention for concomitant MR.
- Asgar A.W.
- Ouzounian M.
- Adams C.
- et al.
2019 Canadian Cardiovascular Society position statement for transcatheter aortic valve implantation.
Can J Cardiol. 2019; 35: 1437-1448
To read this article in full you will need to make a payment
Purchase one-time access:Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
One-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:Subscribe to Canadian Journal of Cardiology
Already a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
- 2014 AHA/ACC guideline for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines.Circulation. 2014; 129: e521-643
- A prospective survey of patients with valvular heart disease in Europe: the Euro Heart Survey on Valvular Heart Disease.Eur Heart J. 2003; 24: 1231-1243
- 2019 Canadian Cardiovascular Society position statement for transcatheter aortic valve implantation.Can J Cardiol. 2019; 35: 1437-1448
- Transcatheter versus surgical aortic-valve replacement in high-risk patients.N Engl J Med. 2011; 364: 2187-2198
- Transcatheter or surgical aortic-valve replacement in intermediate-risk patients.N Engl J Med. 2016; 374: 1609-1620
- Transcatheter aortic-valve replacement with a balloon-expandable valve in low-risk patients.N Engl J Med. 2019; 380: 1695-1705
- Transcatheter aortic-valve replacement with a self-expanding prosthesis.N Engl J Med. 2014; 370: 1790-1798
- Transcatheter aortic-valve replacement with a self-expanding valve in low-risk patients.N Engl J Med. 2019; 380: 1706-1715
- Surgical or transcatheter aortic-valve replacement in intermediate-risk patients.N Engl J Med. 2017; 376: 1321-1331
- Significant mitral regurgitation left untreated at the time of aortic valve replacement: a comprehensive review of a frequent entity in the transcatheter aortic valve replacement era.J Am Coll Cardiol. 2014; 63: 2643-2658
- Transcatheter mitral-valve repair in patients with heart failure.N Engl J Med. 2018; 379: 2307-2318
- Percutaneous repair or surgery for mitral regurgitation.N Engl J Med. 2011; 364: 1395-1406
- Clinical impact of preprocedural moderate or severe mitral regurgitation on outcomes after transcatheter aortic valve replacement.Can J Cardiol. 2020; 36: 1112-1120
- Transcatheter aortic valve replacement in patients with aortic stenosis and mitral regurgitation.Ann Thorac Surg. 2017; 104: 1977-1985
- When transcatheter aortic valve replacement is not enough: a step toward understanding when concomitant mitral regurgitation needs treatment.JACC Cardiovasc Interv. 2016; 9: 1615-1617
- Clinical impact and evolution of mitral regurgitation following transcatheter aortic valve replacement: a meta-analysis.Heart. 2015; 101: 1395-1405
- Mitral regurgitation after transcatheter aortic valve replacement: prognosis, imaging predictors, and potential management.JACC Cardiovasc Interv. 2016; 9: 1603-1614
- Previous TAVR in patients undergoing percutaneous edge-to-edge mitral valve repair (PMVR) affects improvement of MR.PLoS One. 2018; 13 (e0205930)
Published online: December 28, 2019
Accepted: December 11, 2019
Received: December 6, 2019
See article by Miura et al., pages 1112–1120 of this issue.
See page 1004 for disclosure information.
© 2019 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.
ScienceDirectAccess this article on ScienceDirect
- Clinical Impact of Preprocedural Moderate or Severe Mitral Regurgitation on Outcomes After Transcatheter Aortic Valve ReplacementCanadian Journal of CardiologyVol. 36Issue 7