title: Impact of preprocedural mitral regurgitation upon mortality after transcatheter aortic valve implantation (TAVI) for severe aortic stenosis.
abstract: OBJECTIVE
  To identify the effects of preprocedural significant mitral regurgitation (MR) and change in MR severity upon mortality after transcatheter aortic valve implantation (TAVI) using the Edwards SAPIEN system.
  
  
  METHODS
  A retrospective analysis of 316 consecutive patients undergoing TAVI for aortic stenosis at a single centre in the UK between March 2008 and January 2013. Patients were stratified into two groups according to severity of MR: ≥grade 3 were classed as significant and ≤grade 2 were non-significant. Change in MR severity was assessed by comparison of baseline and 30-day echocardiograms.
  
  
  RESULTS
  60 patients had significant MR prior to TAVI (19.0%). These patients were of higher perioperative risk (logistic EuroScore 28.7±16.6% vs 20.3±10.7%, p=0.004) and were more dyspnoeic (New York Heart Association class IV 20.0% vs 7.4%, p=0.014). Patients with significant preprocedural MR displayed greater 12-month and cumulative mortality (28.3% vs 20.2%, log-rank p=0.024). Significant MR was independently associated with mortality (HR 4.94 (95% CI 2.07 to 11.8), p<0.001). Of the 60 patients with significant MR only 47.1% had grade 3-4 MR at 30 days (p<0.001). Patients in whom MR improved had lower mortality than those in whom it deteriorated (log-rank p=0.05).
  
  
  CONCLUSIONS
  Significant MR is frequently seen in patients undergoing TAVI and is independently associated with increased all-cause mortality. Yet almost half also exhibit significant improvements in MR severity. Those who improve have better outcomes, and future work could focus upon identifying factors independently associated with such an improvement.
authors.affiliation: Cardiovascular Division, King's College, British Heart Foundation Centre of Research Excellence, The Rayne Institute, London, UK Guy's & St Thomas' Hospitals NHS Foundation Trust, London, UK.
authors.forename: M Z
authors.initials: MZ
authors.lastname: Khawaja
authors.affiliation: Cardiovascular Division, King's College, British Heart Foundation Centre of Research Excellence, The Rayne Institute, London, UK Guy's & St Thomas' Hospitals NHS Foundation Trust, London, UK.
authors.forename: R
authors.initials: R
authors.lastname: Williams
authors.affiliation: Cardiovascular Division, King's College, British Heart Foundation Centre of Research Excellence, The Rayne Institute, London, UK.
authors.forename: J
authors.initials: J
authors.lastname: Hung
authors.affiliation: Cardiovascular Division, King's College, British Heart Foundation Centre of Research Excellence, The Rayne Institute, London, UK Guy's & St Thomas' Hospitals NHS Foundation Trust, London, UK.
authors.forename: S
authors.initials: S
authors.lastname: Arri
authors.affiliation: Cardiovascular Division, King's College, British Heart Foundation Centre of Research Excellence, The Rayne Institute, London, UK Guy's & St Thomas' Hospitals NHS Foundation Trust, London, UK.
authors.forename: K N
authors.initials: KN
authors.lastname: Asrress
authors.affiliation: Guy's & St Thomas' Hospitals NHS Foundation Trust, London, UK.
authors.forename: K
authors.initials: K
authors.lastname: Bolter
authors.affiliation: Guy's & St Thomas' Hospitals NHS Foundation Trust, London, UK.
authors.forename: K
authors.initials: K
authors.lastname: Wilson
authors.affiliation: Guy's & St Thomas' Hospitals NHS Foundation Trust, London, UK.
authors.forename: C P
authors.initials: CP
authors.lastname: Young
authors.affiliation: Guy's & St Thomas' Hospitals NHS Foundation Trust, London, UK.
authors.forename: V
authors.initials: V
authors.lastname: Bapat
authors.affiliation: Guy's & St Thomas' Hospitals NHS Foundation Trust, London, UK.
authors.forename: J
authors.initials: J
authors.lastname: Hancock
authors.affiliation: Guy's & St Thomas' Hospitals NHS Foundation Trust, London, UK.
authors.forename: M
authors.initials: M
authors.lastname: Thomas
authors.affiliation: Cardiovascular Division, King's College, British Heart Foundation Centre of Research Excellence, The Rayne Institute, London, UK Guy's & St Thomas' Hospitals NHS Foundation Trust, London, UK.
authors.forename: S
authors.initials: S
authors.lastname: Redwood
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D001024:Aortic Valve Stenosis / Q000175:diagnosis / Q000401:mortality* / Q000601:surgery*; D001705:Bioprosthesis; D006328:Cardiac Catheterization / Q000379:methods; D015331:Cohort Studies; D015150:Echocardiography, Doppler / Q000379:methods; D005260:Female; D019918:Heart Valve Prosthesis Implantation / Q000379:methods* / Q000401:mortality*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008944:Mitral Valve Insufficiency / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D011237:Predictive Value of Tests; D011300:Preoperative Care / Q000379:methods; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D015996:Survival Rate; D016896:Treatment Outcome; D006113:United Kingdom