title: Impact of preoperative moderate/severe mitral regurgitation on 2-year outcome after transcatheter and surgical aortic valve replacement: insight from the Placement of Aortic Transcatheter Valve (PARTNER) Trial Cohort A.
abstract: BACKGROUND
  The effect of preoperative mitral regurgitation (MR) on clinical outcomes of patients undergoing transcatheter aortic valve replacement (TAVR) is controversial. This study sought to examine the impact of moderate and severe MR on outcomes after TAVR and surgical aortic valve replacement (SAVR).
  
  
  RESULTS
  Data were drawn from the randomized Placement of Aortic Transcatheter Valve (PARTNER) Trial cohort A patients with severe, symptomatic aortic stenosis undergoing either TAVR (n=331) or SAVR (n=299). Both TAVR and SAVR patients were dichotomized according to the degree of preoperative MR (moderate/severe versus none/mild). At baseline, moderate or severe MR was reported in 65 TAVR patients (19.6%) and 63 SAVR patients (21.2%). At 30 days, among survivors who had isolated SAVR/TAVR, moderate/severe MR had improved in 25 SAVR patients (69.4%) and 30 TAVR patients (57.7%), was unchanged in 10 SAVR patients (27.8%) and 19 TAVR patients (36.5%), and worsened in 1 SAVR patient (2.8%) and 4 TAVR patients (5.8%; all P=NS). Mortality at 2 years was higher in SAVR patients with moderate or severe MR than in those with mild or less MR (49.8% versus 28.1%; adjusted hazard ratio, 1.73; 95% confidence interval, 1.01-2.96; P=0.04). In contrast, MR severity at baseline did not affect mortality in TAVR patients (37.0% versus 32.7%, moderate/severe versus none/mild; hazard ratio, 1.14; 95% confidence interval, 0.72-1.78; P=0.58; P for interaction=0.05).
  
  
  CONCLUSIONS
  Both TAVR and SAVR were associated with a significant early improvement in MR in survivors. However, moderate or severe MR at baseline was associated with increased 2-year mortality after SAVR but not after TAVR. TAVR may be a reasonable option in selected patients with combined aortic and mitral valve disease.
  
  
  BACKGROUND
  http://www.clinicaltrials.gov. Unique identifier: NCT00530894.
authors.affiliation: From St. Paul's Hospital, Vancouver, BC, Canada (M.B., J.G.W., R.H.B., C.R.T.); Columbia University Medical Center/New York-Presbyterian Hospital, New York (R.T.H., C.R.S., S.K., P.G., T.M., I.H., M.B.L.); NorthShore University Health System, Evanston, IL (T.F.); Washington University, St. Louis, MO (A.Z.); Emory University Hospital, Atlanta, GA (V.B.); Cedars-Sinai Medical Center, Los Angeles, CA (R.R.M.); University of Pennsylvania, Philadelphia (W.Y.S.); Duke University Medical Center, Durham, NC (P.S.D.); and Stanford University, Stanford, CA (D.C.M.).
authors.forename: Marco
authors.initials: M
authors.lastname: Barbanti
authors.forename: John G
authors.initials: JG
authors.lastname: Webb
authors.forename: Rebecca T
authors.initials: RT
authors.lastname: Hahn
authors.forename: Ted
authors.initials: T
authors.lastname: Feldman
authors.forename: Robert H
authors.initials: RH
authors.lastname: Boone
authors.forename: Craig R
authors.initials: CR
authors.lastname: Smith
authors.forename: Susheel
authors.initials: S
authors.lastname: Kodali
authors.forename: Alan
authors.initials: A
authors.lastname: Zajarias
authors.forename: Christopher R
authors.initials: CR
authors.lastname: Thompson
authors.forename: Philip
authors.initials: P
authors.lastname: Green
authors.forename: Vasilis
authors.initials: V
authors.lastname: Babaliaros
authors.forename: Raj R
authors.initials: RR
authors.lastname: Makkar
authors.forename: Wilson Y
authors.initials: WY
authors.lastname: Szeto
authors.forename: Pamela S
authors.initials: PS
authors.lastname: Douglas
authors.forename: Tom
authors.initials: T
authors.lastname: McAndrew
authors.forename: Irene
authors.initials: I
authors.lastname: Hueter
authors.forename: D Craig
authors.initials: DC
authors.lastname: Miller
authors.forename: Martin B
authors.initials: MB
authors.lastname: Leon
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve; D001024:Aortic Valve Stenosis / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy*; D006328:Cardiac Catheterization / Q000379:methods*; D006348:Cardiac Surgical Procedures / Q000379:methods*; D015331:Cohort Studies; D004452:Echocardiography; D005260:Female; D005500:Follow-Up Studies; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000295:instrumentation / Q000379:methods*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008944:Mitral Valve Insufficiency / Q000150:complications*; D012720:Severity of Illness Index; D015996:Survival Rate; D016896:Treatment Outcome
keywords: aortic valve; aortic valve stenosis; heart valve prosthesis implantation; mitral valve insufficiency