Abstract
Background
The influence of improved mitral regurgitation (MR) on the outcomes of transcatheter
aortic valve replacement (TAVR) is unknown. Our aim was to determine the impact of
significant preprocedural MR and the improvement of MR after TAVR.
Methods
A population of 1587 patients from the Optimized Catheter Valvular Intervention Transcatheter Aortic Valve Implantation (OCEAN-TAVI) registry were evaluated. Preprocedural MR was mild or less
in 1443 patients (90.9%) and moderate or severe in 144 patients (9.1%).
Results
Moderate or severe MR was associated with increased risk for all-cause mortality at
1 year (adjusted hazard ratio, 1.85; 95% confidence interval [CI], 1.20-2.84; P = 0.005) and 2 years (adjusted hazard ratio, 1.64; 95% CI, 1.15-2.34; P = 0.007). At 6 months after TAVR, the MR grade improved in 77.4% of the patients with
moderate or severe baseline MR. Multivariate analysis showed that the absence of previous
myocardial infarction (odds ratio, 8.00; 95% CI, 1.74-36.8; P = 0.008) and beta-blocker use at baseline (odds ratio, 2.71; 95% CI, 1.09-6.70; P = 0.031) were independently associated with improved MR at 6 months (vs unchanged,
worsened MR, or death). Patients with improved MR had a significantly lower rate of
midterm readmission for heart failure (11.6%) than those with unchanged or worsened
MR (30.8%, P = 0.007).
Conclusions
Moderate or severe MR was associated with increased risk of all-cause mortality 2
years after TAVR. Moderate or severe baseline MR was improved in most patients at
6 months after TAVR. Patients with unchanged or worsened MR had an increased rate
of readmission for heart failure.
Résumé
Contexte
L’effet d’une amélioration de la régurgitation mitrale (RM) sur l’issue du remplacement
valvulaire aortique par cathéter (RVAC) est inconnu. Notre objectif était de déterminer
la portée d’une forte RM préopératoire et l’amélioration de la RM après le RVAC.
Méthodologie
Une population de 1 587 patients inscrits au registre OCEAN-TAVI (Optimized Transcatheter Valvular Intervention-Transcatheter Aortic Valve Implantation) a été évaluée. La RM préopératoire était tout au plus légère chez 1 443 patients
(90,9 %) et modérée ou sévère chez 144 patients (9,1 %).
Résultats
La RM modérée ou sévère était associée à une augmentation du risque de décès toutes
causes confondues à 1 an (rapport des risques instantanés corrigé : 1,85; intervalle
de confiance [IC] à 95 % : 1,20-2,84; p = 0,005) et à 2 ans (rapport des risques instantanés corrigé : 1,64; IC à 95 % : 1,15-2,34;
p = 0,007). Six mois après le RVAC, la classification de la RM indiquait une amélioration
de celle-ci chez 77,4 % des patients qui présentaient initialement une atteinte modérée
ou sévère. Une analyse multivariée a montré que l’absence d’antécédents d’infarctus
du myocarde (rapport de cotes : 8,00; IC à 95 % : 1,74-36,8; p = 0,008) et l’usage de bêtabloquants au départ (rapport de cotes : 2,71; IC à 95 %
: 1,09-6,70; p = 0,031) étaient indépendamment associés à l’amélioration de la RM à 6 mois (vs la
persistance de la RM sans changement, l’aggravation de la RM ou le décès). Chez les
patients présentant une amélioration de la RM, le taux de réhospitalisation à moyen
terme pour cause d’insuffisance cardiaque était significativement moindre (11,6 %)
comparativement aux patients chez qui il y avait persistance de la RM sans changement
ou aggravation de la RM (30,8 %, p = 0,007).
Conclusions
La RM modérée ou sévère était associée à un risque plus élevé de décès toutes causes
confondues deux ans après le RVAC. Une amélioration de la RM initialement modérée
ou sévère est survenue chez la plupart des patients six mois après le RVAC. Un taux
plus élevé de réhospitalisation pour cause d’insuffisance cardiaque a été noté dans
les cas de persistance de la RM sans changement ou d’aggravation de la RM.
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Article info
Publication history
Published online: December 31, 2019
Accepted:
December 16,
2019
Received:
October 26,
2019
Footnotes
See editorial by Sud and Wijeysundera, pages 1003–1005 of this issue.
See page 1119 for disclosure information.
Identification
Copyright
© 2019 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.
ScienceDirect
Access this article on ScienceDirectLinked Article
- Clinical Impact of Valvular Heart Disease in Elderly Patients Admitted for Acute Coronary Syndrome: Insights From the Elderly-ACS 2 StudyCanadian Journal of CardiologyVol. 36Issue 7
- PreviewElderly patients are under-represented in clinical trials and registries, and a gap of evidence exists for clinical decision making in the setting of acute coronary syndromes (ACS). We aimed to assess the prevalence and independent prognostic impact of valvular heart disease (VHD) diagnosed during the index hospitalization on clinical outcomes among elderly patients with ACS. Included VHDs were moderate-to-severe mitral regurgitation (MR), moderate-to-severe aortic stenosis (AS), or both combined.
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- PreviewIn 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.1 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.
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