Transcatheter Treatment of Residual Significant Mitral Regurgitation Following TAVR: A Multicenter Registry

Guy Witberg, Pablo Codner, Uri Landes, Marco Brabanti, Roberto Valvo, Ole De Backer, Joris F. Ooms, Kolja Sievert, Abdallah El Sabbagh, Pilar Jimenez-Quevedo, Paul F. Brennan, Alexander Sedaghat, Giulia Masiero, Paul Werner, Pavel Overtchouk, Yusuke Watanabe, Matteo Montorfano, Venu Reddy Bijjam, Manuel Hein, Claudia FiorinaDabit Arzamendi, Tania Rodriguez-Gabella, Felipe Fernández-Vázquez, Jose A. Baz, Clemence Laperche, Carmelo Grasso, Luca Branca, Rodrigo Estévez-Loureiro, Tomás Benito-González, Ignacio J. Amat Santos, Philipp Ruile, Darren Mylotte, Nicola Buzzatti, Nicolo Piazza, Martin Andreas, Giuseppe Tarantini, Jan Malte Sinning, Mark S. Spence, Luis Nombela-Franco, Mayra Guerrero, Horst Sievert, Lars Sondergaard, Nicolas M. Van Mieghem, Didier Tchetche, John G. Webb, Ran Kornowski

Research output: Contribution to journalArticlepeer-review

Abstract

Objectives: The aim of this study was to describe baseline characteristics, and periprocedural and mid-term outcomes of patients undergoing transcatheter mitral valve interventions post-transcatheter aortic valve replacement (TAVR) and examine their clinical benefit. Background: The optimal management of residual mitral regurgitation (MR) post-TAVR is challenging. Methods: This was an international registry of 23 TAVR centers. Results: In total, 106 of 24,178 patients (0.43%) underwent mitral interventions post-TAVR (100 staged, 6 concomitant), most commonly percutaneous edge-to-edge mitral valve repair (PMVR). The median interval post-TAVR was 164 days. Mean age was 79.5 ± 7.2 years, MR was >moderate in 97.2%, technical success was 99.1%, and 30-day device success rate was 88.7%. There were 18 periprocedural complications (16.9%) including 4 deaths. During a median follow-up of 464 days, the cumulative risk for 3-year mortality was 29.0%. MR grade and New York Heart Association (NYHA) functional class improved dramatically; at 1 year, MR was moderate or less in 90.9% of patients (mild or less in 69.1%), and 85.9% of patients were in NYHA functional class I/II. Staged PMVR was associated with lower mortality versus medical treatment (57.5% vs. 30.8%) in a propensity-matched cohort (n = 156), but this was not statistically significant (hazard ratio: 1.75; p = 0.05). Conclusions: For patients who continue to have significant MR, remain symptomatic post-TAVR, and are anatomically suitable for transcatheter interventions, these interventions are feasible, safe, and associated with significant improvement in MR grade and NYHA functional class. These results apply mainly to PMVR. A staged PMVR strategy was associated with markedly lower mortality, but this was not statistically significant. (Transcatheter Treatment for Combined Aortic and Mitral Valve Disease. The Aortic+Mitral TRAnsCatheter Valve Registry [AMTRAC]; NCT04031274)

Original languageEnglish
Pages (from-to)2782-2791
Number of pages10
JournalJACC: Cardiovascular Interventions
Volume13
Issue number23
DOIs
Publication statusPublished - Dec 14 2020

Keywords

  • aortic stenosis
  • mitral regurgitation
  • TAVR
  • TMVR/r

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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