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Change in mitral regurgitation severity impacts survival after transcatheter aortic valve replacement
Karolinska Inst, Unit Cardiol, Dept Med, Stockholm, Sweden;Karolinska Univ Hosp, Dept Cardiol, Heart & Vasc Theme, S-17176 Stockholm, Sweden.
Buckinghamshire NHS Trust, Amersham, Bucks, England;Karolinska Inst, Unit Cardiol, Dept Med, S-17176 Stockholm, Sweden.
Lund Univ, Lund Univ Hosp, S-22242 Lund, Sweden.
Gothenburg Univ, Dept Med, Sahlgrenska Univ Hosp, S-41345 Gothenburg, Sweden.
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2019 (English)In: International Journal of Cardiology, ISSN 0167-5273, E-ISSN 1874-1754, Vol. 294, p. 32-36Article in journal (Refereed) Published
Abstract [en]

Background: The impact of a change in mitral regurgitation (MR) following TAVR is unknown. We studied the impact of baseline MR and early post-procedural change in MR on survival following TAVR.

Methods: The SWEDEHEART registry included all TAVRs performed in Sweden. Patients were dichotomized into no/mild and moderate/severe MR groups. Vital status, echocardiographic data at baseline and within 7 days after TAVR were analyzed.

Results: 1712 patients were included. 1404 (82%) had no/mild MR and 308 (18%) had moderate/severe MR. Baseline moderate/severe MR conferred a higher mortality rate at 5-year follow-up (adjusted HR 1.29, CI 1.01-1.65, p = 0.04). Using persistent <= mild MR as the reference, when moderate/severe MR persisted or if MR worsened from <= mild at baseline to moderate/severe after TAVR, higher 5-year mortality rates were seen (adjusted HR 1.66, CI 1.17-2.34, p = 0.04; adjusted HR 1.97, CI 1.29-3.00, p = 0.002, respectively). If baseline moderate/severe MR improved to = mild after TAVR no excess mortality was seen (HR 1.09, CI 0.75-1.58, p = 0.67). Paravalvular aortic regurgitation (PVL) was inversely associated with MR improvement after TAVR (OR 0.4, 95%: CI 0.17-0.94; p = 0.034). Atrial fibrillation (OR 2.1, 95% CI: 1.27-3.39, p = 0.004), self-expanding valve (OR 3.8, 95% CI: 2.08-7.14, p < 0.0001), and PVL (4.3, 95% CI 2.32-7.78. p < 0.0001) were associated with MR worsening.

Conclusions: Moderate/severe baseline MR in patients undergoing TAVR is associated with a mortality increase during 5 years of follow-up. This risk is offset if MR improves to <= mild, whereas worsening of MR after TAVR is associated with a 2-fold mortality increase.

Place, publisher, year, edition, pages
2019. Vol. 294, p. 32-36
Keywords [en]
TAVR, Mitral regurgitation, Survival, Prognosis, Long-term
National Category
Cardiac and Cardiovascular Systems
Identifiers
URN: urn:nbn:se:uu:diva-394943DOI: 10.1016/j.ijcard.2019.07.075ISI: 000485263500009PubMedID: 31399298OAI: oai:DiVA.org:uu-394943DiVA, id: diva2:1362753
Available from: 2019-10-21 Created: 2019-10-21 Last updated: 2019-10-21Bibliographically approved

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