NCDR Study Examines Link Between MR and Mortality, Rehab in TAVR Patients

Moderate or severe mitral regurgitation (MR) may be associated with increased mortality or heart failure (HF) rehospitalization in patients who undergo transcatheter aortic valve replacement (TAVR), according to a study published Sept. 29 in The Annals of Thoracic Surgery.

Using data from the STS/ACC TVT Registry, Kreton Mavromatis, MD, FACC, et al., reviewed 11,104 records of patients who underwent a TAVR procedure for aortic valve stenosis (AS) between Jan. 3, 2012, and Dec. 31, 2013. The researchers excluded patients who had prior mitral valve replacement, as well as those without baseline MR data. After dividing MR severity into four groups (none, mild, moderate and severe), the researchers conducted statistical modeling to determine mortality and mortality or HF at 30 days and one year after TAVR.

Results showed that at baseline, 36.8 percent of patients had moderate or severe MR. After adjusting for independent predictors of mortality, higher MR severity was associated with 30-day mortality or HF rehospitalization. Similarly, there was a link between higher MR severity and mortality or HF rehospitalization.

After undergoing TAVR, MR severity improved by at least one grade for 79 percent of patients with severe MR and 66 percent with moderate MR. Furthermore, patients with improved MR had lower risk of mortality or HF rehospitalization compared with those whose MR severity was unchanged or worse. The researchers identified several factors linked to persistent MR, including smaller body surface area, pre-TAVR atrial fibrillation/flutter and prior aortic valve procedure.

According to the authors, the study establishes the association of moderate and severe MR with TAVR clinical outcomes in AS patients and demonstrates that MR improves after TAVR for many patients. For the majority of patients whose baseline MR was severe or moderate, MR improved soon after the TAVR procedure, suggesting that a staged approach to treating AS in MR patients may be reasonable, the authors write. In patients who are unlikely to have MR improvement after TAVR, the authors conclude that treatment strategies could include double valve surgery or TAVR with percutaneous mitral valve repair. Further treatment, such as mitral valve repair or replacement, could be considered in patients who undergo TAVR but whose MR does not improve.

Clinical Topics: Arrhythmias and Clinical EP, Cardiac Surgery, Heart Failure and Cardiomyopathies, Invasive Cardiovascular Angiography and Intervention, Valvular Heart Disease, Atrial Fibrillation/Supraventricular Arrhythmias, Aortic Surgery, Cardiac Surgery and Arrhythmias, Cardiac Surgery and Heart Failure, Cardiac Surgery and VHD, Acute Heart Failure, Interventions and Structural Heart Disease, Mitral Regurgitation

Keywords: Transcatheter Aortic Valve Replacement, Aortic Valve, Mitral Valve Insufficiency, Mitral Valve, Thoracic Surgery, Body Surface Area, Atrial Fibrillation, Aortic Valve Stenosis, Registries, Heart Failure, National Cardiovascular Data Registries, STS/ACC TVT Registry

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