Advertisement
Canadian Journal of Cardiology

Persistent Mitral Regurgitation After TAVR—Where to From Here?

  • Maneesh Sud
    Affiliations
    Schulich Heart Center, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
    Search for articles by this author
  • Harindra C. Wijeysundera
    Correspondence
    Corresponding author: Dr Harindra C. Wijeysundera, Interventional Cardiology, Schulich Heart Centre, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Suite A202, Toronto, Ontario M4N 3M5, Canada.
    Affiliations
    Schulich Heart Center, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada

    Sunnybrook Research Institute, Toronto, Ontario, Canada

    Institute for Clinical Evaluative Sciences, Institute for Health Policy, Management, and Evaluation, Toronto, Ontario, Canada
    Search for articles by this author
Published:December 28, 2019DOI:https://doi.org/10.1016/j.cjca.2019.12.016
      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.
      • 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.
      Despite 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.
      • 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.
      With the emergence of transcatheter aortic valve replacement (TAVR) as a viable and often preferable treatment strategy for patients with AS,
      • Asgar A.W.
      • Ouzounian M.
      • Adams C.
      • et al.
      2019 Canadian Cardiovascular Society position statement for transcatheter aortic valve implantation.
      there is a growing need to reevaluate the role, timing, and mode of mitral valve intervention for concomitant MR.
      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
      Institutional Access: Sign in to ScienceDirect

      References

        • 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
        • 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
        • 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
        • Smith C.R.
        • Leon M.B.
        • Mack M.J.
        • et al.
        Transcatheter versus surgical aortic-valve replacement in high-risk patients.
        N Engl J Med. 2011; 364: 2187-2198
        • Leon M.B.
        • Smith C.R.
        • Mack M.J.
        • et al.
        Transcatheter or surgical aortic-valve replacement in intermediate-risk patients.
        N Engl J Med. 2016; 374: 1609-1620
        • Mack M.J.
        • Leon M.B.
        • Thourani V.H.
        • et al.
        Transcatheter aortic-valve replacement with a balloon-expandable valve in low-risk patients.
        N Engl J Med. 2019; 380: 1695-1705
        • Adams D.H.
        • Popma J.J.
        • Reardon M.J.
        • et al.
        Transcatheter aortic-valve replacement with a self-expanding prosthesis.
        N Engl J Med. 2014; 370: 1790-1798
        • Popma J.J.
        • Deeb G.M.
        • Yakubov S.J.
        • et al.
        Transcatheter aortic-valve replacement with a self-expanding valve in low-risk patients.
        N Engl J Med. 2019; 380: 1706-1715
        • Reardon M.J.
        • Van Mieghem N.M.
        • Popma J.J.
        • et al.
        Surgical or transcatheter aortic-valve replacement in intermediate-risk patients.
        N Engl J Med. 2017; 376: 1321-1331
        • Nombela-Franco L.
        • Ribeiro H.B.
        • Urena M.
        • et al.
        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
        • Stone G.W.
        • Lindenfeld J.
        • Abraham W.T.
        • et al.
        Transcatheter mitral-valve repair in patients with heart failure.
        N Engl J Med. 2018; 379: 2307-2318
        • Feldman T.
        • Foster E.
        • Glower D.D.
        • et al.
        Percutaneous repair or surgery for mitral regurgitation.
        N Engl J Med. 2011; 364: 1395-1406
        • Miura M.
        • Yamaji K.
        • Shirai S.
        • et al.
        Clinical impact of preprocedural moderate or severe mitral regurgitation on outcomes after transcatheter aortic valve replacement.
        Can J Cardiol. 2020; 36: 1112-1120
        • Mavromatis K.
        • Thourani V.H.
        • Stebbins A.
        • et al.
        Transcatheter aortic valve replacement in patients with aortic stenosis and mitral regurgitation.
        Ann Thorac Surg. 2017; 104: 1977-1985
        • Mavromatis K.
        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
        • Nombela-Franco L.
        • Eltchaninoff H.
        • Zahn R.
        • et al.
        Clinical impact and evolution of mitral regurgitation following transcatheter aortic valve replacement: a meta-analysis.
        Heart. 2015; 101: 1395-1405
        • Cortes C.
        • Amat-Santos I.J.
        • Nombela-Franco L.
        • et al.
        Mitral regurgitation after transcatheter aortic valve replacement: prognosis, imaging predictors, and potential management.
        JACC Cardiovasc Interv. 2016; 9: 1603-1614
        • Patzelt J.
        • Ulrich M.
        • Becker A.
        • et al.
        Previous TAVR in patients undergoing percutaneous edge-to-edge mitral valve repair (PMVR) affects improvement of MR.
        PLoS One. 2018; 13 (e0205930)

      Linked Article