TY - JOUR
T1 - Interplay between mitral regurgitation and transcatheter aortic valve replacement with the corevalve revalving system
T2 - A multicenter registry
AU - Bedogni, Francesco
AU - Latib, Azeem
AU - De Marco, Federico
AU - Agnifili, Mauro
AU - Oreglia, Jacopo
AU - Pizzocri, Samuele
AU - Latini, Roberto A.
AU - Lanotte, Stefania
AU - Petronio, Anna Sonia
AU - De Carlo, Marco
AU - Ettori, Federica
AU - Fiorina, Claudia
AU - Poli, Arnaldo
AU - Cirri, Silvia
AU - De Servi, Stefano
AU - Ramondo, Angelo
AU - Tarantini, Giuseppe
AU - Marzocchi, Antonio
AU - Fiorilli, Rosario
AU - Klugmann, Silvio
AU - Ussia, Gian Paolo
AU - Tamburino, Corrado
AU - Maisano, Francesco
AU - Brambilla, Nedy
AU - Colombo, Antonio
AU - Testa, Luca
PY - 2013/11/5
Y1 - 2013/11/5
N2 - BACKGROUND - : Little is known of the prognostic significance of mitral regurgitation (MR) on transcatheter aortic valve replacement (TAVR), the impact of TAVR on MR severity, and the variables associated with possible post-TAVR improvement in MR. We evaluated these issues in a multicenter registry of patients undergoing CoreValve Revalving System-TAVR. METHODS AND RESULTS - : Among 1007 consecutive patients, 670 (66.5%), 243 (24.1%), and 94 (9.3%) presented with no/mild, moderate, and severe MR, respectively. At 1 month after TAVR, patients with severe or moderate MR showed comparable mortality rates (odds ratio, 1.1; 95% confidence interval [95% CI], 0.7-1.55; P=0.2), but both were significantly higher compared with patients with mild/no MR (odds ratio, 2.2; 95% CI, 1.78-3.28; P<0.001; and odds ratio, 1.9; 95% CI, 1.1-3.3; P=0.02, respectively).One-year mortality was also similar between patients with severe and those with moderate MR (hazard ratio, 1.4; 95% CI, 0.94-2.4; P=0.06) and still significantly higher compared with patients with mild/no MR (hazard ratio, 1.7; 95% CI, 1.2-3.41; P<0.001; and hazard ratio, 1.4; 95% CI, 1.2-2.2; P=0.03, respectively). Severe pulmonary hypertension, atrial fibrillation, and MR more than mild, but not an improvement of ≥1 grade in MR severity, were independent predictors of mortality at 1 year. At 1 year, an improved MR was observed in 47% and 35% of patients with severe and moderate MR, respectively. The rate of low implantation was consistent across groups with improved, unchanged, or worsened MR. A functional type of MR and the absence of severe pulmonary hypertension and atrial fibrillation independently predicted the improvement in MR severity. CONCLUSIONS - : Baseline MR greater than mild is associated with higher mortality after CoreValve Revalving System-TAVR. A significant improvement in MR was more likely in patients with functional MR and without severe pulmonary hypertension or atrial fibrillation. The improvement in MR did not independently predict mortality.
AB - BACKGROUND - : Little is known of the prognostic significance of mitral regurgitation (MR) on transcatheter aortic valve replacement (TAVR), the impact of TAVR on MR severity, and the variables associated with possible post-TAVR improvement in MR. We evaluated these issues in a multicenter registry of patients undergoing CoreValve Revalving System-TAVR. METHODS AND RESULTS - : Among 1007 consecutive patients, 670 (66.5%), 243 (24.1%), and 94 (9.3%) presented with no/mild, moderate, and severe MR, respectively. At 1 month after TAVR, patients with severe or moderate MR showed comparable mortality rates (odds ratio, 1.1; 95% confidence interval [95% CI], 0.7-1.55; P=0.2), but both were significantly higher compared with patients with mild/no MR (odds ratio, 2.2; 95% CI, 1.78-3.28; P<0.001; and odds ratio, 1.9; 95% CI, 1.1-3.3; P=0.02, respectively).One-year mortality was also similar between patients with severe and those with moderate MR (hazard ratio, 1.4; 95% CI, 0.94-2.4; P=0.06) and still significantly higher compared with patients with mild/no MR (hazard ratio, 1.7; 95% CI, 1.2-3.41; P<0.001; and hazard ratio, 1.4; 95% CI, 1.2-2.2; P=0.03, respectively). Severe pulmonary hypertension, atrial fibrillation, and MR more than mild, but not an improvement of ≥1 grade in MR severity, were independent predictors of mortality at 1 year. At 1 year, an improved MR was observed in 47% and 35% of patients with severe and moderate MR, respectively. The rate of low implantation was consistent across groups with improved, unchanged, or worsened MR. A functional type of MR and the absence of severe pulmonary hypertension and atrial fibrillation independently predicted the improvement in MR severity. CONCLUSIONS - : Baseline MR greater than mild is associated with higher mortality after CoreValve Revalving System-TAVR. A significant improvement in MR was more likely in patients with functional MR and without severe pulmonary hypertension or atrial fibrillation. The improvement in MR did not independently predict mortality.
KW - aortic valve
KW - aortic valve stenosis
KW - mitral valve insufficiency
UR - http://www.scopus.com/inward/record.url?scp=84887209841&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84887209841&partnerID=8YFLogxK
U2 - 10.1161/CIRCULATIONAHA.113.001822
DO - 10.1161/CIRCULATIONAHA.113.001822
M3 - Article
C2 - 24088530
AN - SCOPUS:84887209841
SN - 0009-7322
VL - 128
SP - 2145
EP - 2153
JO - Circulation
JF - Circulation
IS - 19
ER -