title: Outcome and improvement predictors of mitral regurgitation after transcatheter aortic valve implantation.
abstract: OBJECTIVE
  Mitral regurgitation (MR) is frequently present in patients with calcific aortic stenosis (AS). Yet, the issue of whether to surgically correct the MR during aortic valve replacement (AVR) remains uncertain. The study aim was to define the outcome of MR after transcatheter aortic valve implantation (TAVI) in the TRanscatheter EndoVascular Implantation of VALves (REVIVAL) II trial.
  
  
  METHODS
  Echocardiography was performed before and at 24 h, and three and six months after valve implantation. The degree of MR was evaluated by expert readers and by the vena contracta (VC) method. Significant MR was defined as at least mild to moderate MR. Those patients with a 30% reduction in VC were classified as good responders (GR group), and the remainder as poor responders (PR group).
  
  
  RESULTS
  The study comprised 35 subjects with at least mild to moderate MR before TAVI. The mean VC of the whole group declined from 0.5 +/- 0.2 cm initially to 0.32 +/- 0.2 cm and 0.38 +/- 0.2 cm at 24 h and three months, respectively (p < 0.05). At three months, 12 patients had > 30% VC reduction; these constituted the GR group, while the remainder constituted the PR group. The percentage of patients with mitral annular calcification with restriction (MACr), defined as calcification encroaching onto the leaflets and restricting leaflet motion, was significantly lower in the GR group compared to the PR group (17% versus 61%, respectively; p < 0.05). The remaining pre-specified parameters did not differ significantly between the GR and PR groups, including age, gender, mitral valve tethering height and area (6 +/- 2 mm versus 5 +/- 3 mm and 10 +/- 4 mm2 versus 13 +/- 9 and 10 +/- 4 mm2, respectively), change in the aortic valve area (336 +/- 130% versus 285 +/- 180%), change in mean systolic aortic valve pressure (-20 +/- 8% versus - 23 +/- 10%), and left ventricular ejection fraction (47 +/- 15% versus 45 +/- 18%).
  
  
  CONCLUSIONS
  MR is improved significantly after TAVI for AS. MACr was the only variable associated with a reduction in MR improvement. These results suggest that a careful echocardiographic evaluation of the mitral valve prior to TAVI may help to predict which patients should experience an improvement in their MR.
authors.affiliation: Cardiac Ultrasound Laboratory and Division of Cardiology, Massachusetts General Hospital, Boston, MA 02114, USA.
authors.forename: Ronen
authors.initials: R
authors.lastname: Durst
authors.forename: Erick
authors.initials: E
authors.lastname: Avelar
authors.forename: David
authors.initials: D
authors.lastname: McCarty
authors.forename: Kian-Keong
authors.initials: KK
authors.lastname: Poh
authors.forename: Leticia Fernandez
authors.initials: LF
authors.lastname: Friera
authors.forename: Miguel F
authors.initials: MF
authors.lastname: Llano
authors.forename: John
authors.initials: J
authors.lastname: Chu
authors.forename: Anil Kumar Reddy
authors.initials: AK
authors.lastname: Anumandla
authors.forename: Leonardo L
authors.initials: LL
authors.lastname: Rodriguez
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Mack
authors.forename: George
authors.initials: G
authors.lastname: Hanzel
authors.forename: Susheel K
authors.initials: SK
authors.lastname: Kodali
authors.forename: Judy
authors.initials: J
authors.lastname: Hung
authors.forename: Michael H
authors.initials: MH
authors.lastname: Picard
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000150:complications / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy*; D006328:Cardiac Catheterization / Q000295:instrumentation; D016009:Chi-Square Distribution; D018618:Echocardiography, Doppler, Color; D017548:Echocardiography, Transesophageal; D005260:Female; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000295:instrumentation / Q000379:methods*; D006801:Humans; D008297:Male; D008944:Mitral Valve Insufficiency / Q000150:complications* / Q000000981:diagnostic imaging / Q000503:physiopathology; D011474:Prosthesis Design; D020127:Recovery of Function; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States