Mitral Regurgitation Associated with Decreased Survival in TAVR Patients

BARCELONA, Spain—Postprocedural mitral regurgitation (MR) predicts survival in patients undergoing transcatheter aortic valve replacement (TAVR), according to results presented on September 3, 2014, at the European Society of Cardiology Congress.

Overall 30-day mortality was 5%, and echo-Doppler follow-up was available in 97% of survivors (n = 410). While MR grade < 2 was observed in most patients (84%), 66 had grade ≥ 2. Postprocedural MR grade was directly associated with both mortality (primary endpoint; P = .0042 for trend) and the combination of mortality, new onset A-fib, and hospitalization for heart failure (P < .0001 for trend).

MR grade ≥ 2 was associated with a lower risk of survival and event-free survival (table 1).

Table 1. Effect on Mortality: MR Grade < 2 vs ≥ 2

 

Preprocedural A-fib tended to increase the likelihood of mitral regurgitation grade ≥ 2 (P = .063), and preprocedural mitral regurgitation grade ≥ 2 was associated with increased prevalence of postprocedural mitral regurgitation grade ≥ 2 (P < .0001). Predictors of mortality on multivariate analysis included:

• Age (P = .01)
• Grade ≥ 2 postprocedural paravalvular leak (P = .032)
• Low flow, stroke volume index < 35 ml/m² (P = .0085)

 Lastly, while A-fib tended to predict the secondary endpoint (P = .08), grade ≥ 2 postprocedural MR was an independent predictor on multivariate analysis (P > .0001).

“The clinical consequences of postprocedural grade of 2 or higher mitral regurgitation are probably mediated by unfavorable changes in LV geometry and loading conditions,” Dr. Biner concluded.

 

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Source:
Biner S. Two-year clinical outcome of post procedural mitral regurgitation after transcatheter aortic valve replacement. Presented at: European Society of Cardiology Congress; September 3, 2014; Barcelona, Spain.

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