Transcatheter Aortic Valve Replacement: Outcomes of Patients With Moderate or Severe Mitral Regurgitation

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• 作者：Stefan Toggweiler ; MD^鈦?/sup> ; Robert H. Boone ; MD^鈦?/sup> ; Josep Rodé ; s-Cabau ; MD^&dagger ; ; Karin H. Humphries ; PhD^鈦?/sup> ; May Lee ; PhD^鈦?/sup> ; Luis Nombela-Franco ; MD^&dagger ; ; Rodrigo Bagur ; MD^&dagger ; ; Alexander B. Willson ; MBBS^鈦?/sup> ; Ronald K. Binder ; MD^鈦?/sup> ; Ronen Gurvitch ; MBBS^鈦?/sup> ; Jasmine Grewal ; MD^鈦?/sup> ; Robert Moss ; MD^鈦?/sup> ; Brad Munt ; MD^鈦?/sup> ; Christopher R. Thompson ; MD^鈦?/sup> ; Melanie Freeman ; MBBS^鈦?/sup> ; Jian Ye ; MD^鈦?/sup> ; Anson Cheung ; MD^鈦?/sup> ; Eric Dumont ; MD^&dagger ; ; David A. Wood ; MD^鈦?/sup> ; John G. Webb ; MD^鈦?/sup> ; ^{john.webb@vch.ca}
• 关键词：aortic valve ; mitral regurgitation ; transcatheter aortic valve regurgitation ; transcatheter aortic valve replacement
• 刊名：Journal of the American College of Cardiology
• 出版年：2012
• 期刊代码：201_07351097
• 类别：med
• 出版时间：5 June, 2012
• 卷：59
• 期：23
• 页码：2068-2074
• 文件大小：579 K

摘要

| Figures/TablesFigures/Tables | ReferencesReferences<h4 class="h4">Objectivesh4>The aim of this study was to evaluate the impact of mitral regurgitation (MR) on outcomes after transcatheter aortic valve replacement (TAVR) and the impact of TAVR on MR.<h4 class="h4">Backgroundh4>

Little is known of the influence of MR on outcomes after TAVR.<h4 class="h4">Methodsh4>

The outcomes of patients with mild or less (n = 319), moderate (n = 89), and severe (n = 43) MR were evaluated after TAVR at 2 Canadian centers.<h4 class="h4">Resultsh4>

Patients with moderate or severe MR had a higher mortality rate than those with mild or less MR during the 30 days after TAVR (adjusted hazard ratio: 2.10; 95%confidence interval: 1.12 to 3.94; p = 0.02). However, the mortality rates after 30 days were similar (adjusted hazard ratio: 0.82; 95%confidence interval: 0.50 to 1.34; p = 0.42). One year after TAVR, moderate MR had improved in 58%, remained moderate in 17%, and worsened to severe in 1%, and 24%of patients had died. Severe MR had improved in 49%and remained severe in 16%, and 35%of patients had died. Multivariate predictors of improved MR at 1 year (vs. unchanged MR, worse MR, or death) were a mean transaortic gradient 鈮?0 mm Hg, functional (as opposed to structural) MR, the absence of pulmonary hypertension, and the absence of atrial fibrillation.<h4 class="h4">Conclusionsh4>

Moderate or severe MR in patients undergoing TAVR is associated with a higher early, but not late, mortality rate. At 1-year follow-up, MR was improved in 55%of patients with moderate or severe MR at baseline. Improvement was more likely in patients with high transaortic gradients, with functional MR, without pulmonary hypertension and without atrial fibrillation.