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Impact of concomitant mitral regurgitation during transcatheter aortic valve replacement on 1-year survival outcomes

Published:January 24, 2023DOI:https://doi.org/10.1016/j.jjcc.2023.01.002

      Highlights

      • The influence of mitral regurgitation (MR) on transcatheter aortic valve replacement procedure was studied using the Japan-TVT registry.
      • 1-year follow―up data were obtained from 25,979 patients (follow-up rate 98.5 %).
      • Propensity-score matching was employed.
      • Survival was similar among patients with or without moderate or severe MR.
      • Death and/or heart failure occurred more in patients with moderate or severe MR.

      Abstract

      Background

      We investigated the influence of concomitant mitral regurgitation (MR) in patients undergoing transcatheter aortic valve implantation on the 1-year outcome using Japan Transcatheter Valve Therapy (J-TVT) registry data.

      Methods

      The patients who underwent the transcatheter aortic valve implantation for aortic stenosis performed from August 2013 to December 2019 in Japan were included. History of previous valve surgery and dialysis patients were excluded. A total of 24,979 patients were included, and 1-year follow-up data were obtained from the registry (follow-up rate 98.5 %). Propensity-score matching, using multivariable logistic regression and 1:1 matching without replacement, was performed between the patients with grade 3–4 MR (MR 3–4 group) and those with grade 0–2 MR (MR 0–2 group). All-cause death and the composite outcome of death and/or heart failure events were compared.

      Results

      After propensity score matching, 3920 cases (1960 cases each in MR 0–2 group and MR 3–4 group) were extracted. The procedure success rate was 96.4 % in MR 0–2 and 96.0 % in MR 3–4 group (p = 0.56) and the surgical conversion rate was 0.7 % in MR 0–2 group and 0.8 % in MR 3–4 group (p = 0.58). Cox regression model showed no statistical difference in 1-year survival rate between MR 0–2 group (89.4 %) and MR 3–4 group (89.6 %) (p = 0.80). However, freedom from 1-year death and/or heart failure event was lower in MR 3–4 (86.3 %) than in MR 0–2 group (88.9 %) (p = 0.01). This trend was also found in the subgroup of New York Heart Association (NYHA) class 1–2 but not in the subgroup of NYHA class 3–4.

      Conclusions

      One-year survival rate was not different between groups but freedom from death and/or heart failure events was lower in patients with preoperative MR grade 3–4 than in patients with preoperative MR grade 0–2 after transcatheter aortic valve replacement.

      Graphical abstract

      Keywords

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      References

        • Khan F.
        • Okuno T.
        • Malebranche D.
        • Lanz J.
        • Praz F.
        • Stortecky S.
        • et al.
        Transcatheter aortic valve replacement in patients with multivalvular heart disease.
        JACC Cardiovasc Interv. 2020; 13: 1503-1514
        • Jorgensen T.H.
        • Thyregod H.G.H.
        • Ihlemann N.
        • Nissen H.
        • Petursson P.
        • Kjeldsen B.J.
        • et al.
        Eight-year outcomes for patients with aortic valve stenosis at low surgical risk randomized to transcatheter vs. Surgical aortic valve replacement.
        Eur Heart J. 2021; 42: 2912-2919
        • Beyersdorf F.
        • Bauer T.
        • Freemantle N.
        • Walther T.
        • Frerker C.
        • Herrmann E.
        • et al.
        Five-year outcome in 18 010 patients from the german aortic valve registry.
        Eur J Cardiothorac Surg. 2021; 60: 1139-1146
        • Popma J.J.
        • Deeb G.M.
        • Yakubov S.J.
        • Mumtaz M.
        • Gada H.
        • O’Hair D.
        • et al.
        Transcatheter aortic-valve replacement with a self-expanding valve in low-risk patients.
        N Engl J Med. 2019; 380: 1706-1715
        • Thourani V.H.
        • Kodali S.
        • Makkar R.R.
        • Herrmann H.C.
        • Williams M.
        • Babaliaros V.
        • et al.
        Transcatheter aortic valve replacement versus surgical valve replacement in intermediate-risk patients: a propensity score analysis.
        Lancet. 2016; 387: 2218-2225
        • Kaneko T.
        • Vemulapalli S.
        • Kohsaka S.
        • Shimamura K.
        • Stebbins A.
        • Kumamaru H.
        • et al.
        Practice patterns and outcomes of transcatheter aortic valve replacement in the United States and Japan: a report from joint data harmonization initiative of STS/ACC TVT and J-TVT.
        J Am Heart Assoc. 2022; 11e023848
        • Mavromatis K.
        • Thourani V.H.
        • Stebbins A.
        • Vemulapalli S.
        • Devireddy C.
        • Guyton R.A.
        • et al.
        Transcatheter aortic valve replacement in patients with aortic stenosis and mitral regurgitation.
        Ann Thorac Surg. 2017; 104: 1977-1985
        • Fojt R.
        • Moťovská Z.
        • Budera P.
        • Malý M.
        • Straka Z.
        Prognostic impact and change of concomitant mitral regurgitation after surgical or transcatheter aortic valve replacement for aortic stenosis.
        J Cardiol. 2016; 67: 526-530
        • Harling L.
        • Saso S.
        • Jarral O.A.
        • Kourliouros A.
        • Kidher E.
        • Athanasiou T.
        Aortic valve replacement for aortic stenosis in patients with concomitant mitral regurgitation: should the mitral valve be dealt with?.
        Eur J Cardiothorac Surg. 2011; 40: 1087-1096
        • Nombela-Franco L.
        • Eltchaninoff H.
        • Zahn R.
        • Testa L.
        • Leon M.B.
        • Trillo-Nouche R.
        • et al.
        Clinical impact and evolution of mitral regurgitation following transcatheter aortic valve replacement: a meta-analysis.
        Heart. 2015; 101: 1395-1405
        • Sannino A.
        • Grayburn P.A.
        Mitral regurgitation in patients with severe aortic stenosis: diagnosis and management.
        Heart. 2018; 104: 16-22
        • Little S.H.
        • Popma J.J.
        • Kleiman N.S.
        • Deeb G.M.
        • Gleason T.G.
        • Yakubov S.J.
        • et al.
        Transcatheter aortic valve replacement in patients with severe mitral or tricuspid regurgitation at extreme risk for surgery.
        J Thorac Cardiovasc Surg. 2018; 155: 1991-1999
        • Abdelghani M.
        • Abdel-Wahab M.
        • Hemetsberger R.
        • Landt M.
        • Merten C.
        • Toelg R.
        • et al.
        Fate and long-term prognostic implications of mitral regurgitation in patients undergoing transcatheter aortic valve replacement.
        Int J Cardiol. 2019; 288: 39-43
        • Sethi A.
        • Kodumuri V.
        • Prasad V.
        • Chaudhary A.
        • Coromilas J.
        • Kassotis J.
        Does the presence of significant mitral regurgitation prior to transcatheter aortic valve implantation for aortic stenosis impact mortality? - meta-analysis and systematic review.
        Cardiology. 2020; 145: 428-438
        • Feldt K.
        • De Palma R.
        • Bjursten H.
        • Petursson P.
        • Nielsen N.E.
        • Kellerth T.
        • et al.
        Change in mitral regurgitation severity impacts survival after transcatheter aortic valve replacement.
        Int J Cardiol. 2019; 294: 32-36
        • Yamashita Y.
        • Sonoda H.
        • Ushijima T.
        • Shiose A.
        Acute torrential mitral regurgitation during transcatheter aortic valve replacement: a case report.
        Surg Case Rep. 2018; 4: 35
        • Feng D.
        • Zhang C.
        • Wang J.
        • Lin B.
        • Li Y.
        • Wei L.
        Simultaneous transcatheter aortic mitral and tricuspid valve-in-valve implantation.
        Eur Heart J. 2022; 43: 433
        • Miura M.
        • Yamaji K.
        • Shirai S.
        • Hayashi M.
        • Kawaguchi T.
        • Arai Y.
        • et al.
        Clinical impact of preprocedural moderate or severe mitral regurgitation on outcomes after transcatheter aortic valve replacement.
        Can J Cardiol. 2020; 36: 1112-1120
        • Murdoch D.J.
        • Sathananthan J.
        • Hensey M.
        • Alu M.C.
        • Liu Y.
        • Crowley A.
        • et al.
        Mitral regurgitation in patients undergoing transcatheter aortic valve implantation for degenerated surgical aortic bioprosthesis: insights from PARTNER 2 valve-in-valve registry.
        Catheter Cardiovasc Interv. 2020; 96: 981-986
        • Kiramijyan S.
        • Koifman E.
        • Asch F.M.
        • Magalhaes M.A.
        • Didier R.
        • Escarcega R.O.
        • et al.
        Impact of functional versus organic baseline mitral regurgitation on short- and long-term outcomes after transcatheter aortic valve replacement.
        Am J Cardiol. 2016; 117: 839-846