title: Meta-analysis of the impact of mitral regurgitation on outcomes after transcatheter aortic valve implantation.
abstract: Significant mitral regurgitation (MR) constitutes an important co-existing valvular heart disease burden in the setting of aortic valve stenosis. There are conflicting reports on the impact of significant MR on outcomes after transcatheter aortic valve implantation (TAVI). We evaluated the impact of MR on outcomes after TAVI by performing a meta-analysis of 8 studies involving 8,927 patients reporting TAVI outcomes based on the presence or absence of moderate-severe MR. Risk ratios (RRs) were calculated using the inverse variance random-effects model. None-mild MR was present in 77.8% and moderate-severe MR in 22.2% of the patients. The presence of moderate-severe MR at baseline was associated with increased mortality at 30 days (RR 1.35, 95% confidence interval [CI] 1.14 to 1.59, p = 0.003) and 1 year (RR 1.24, 95% CI 1.13 to 1.37, p <0.0001). The increased mortality associated with moderate-severe MR was not influenced by the cause of MR (functional or degenerative MR; RR 0.90, 95% CI 0.62 to 1.30, p = 0.56). The severity of MR improved in 61 ± 6.0% of patients after TAVI. Moderate-severe residual MR, compared with none-mild residual MR after TAVI, was associated with significantly increased 1-year mortality (RR 1.48, 95% CI 1.31 to 1.68, p <0.00001). In conclusion, baseline moderate-severe MR and significant residual MR after TAVI are associated with an increase in mortality after TAVI and represent an important group to target with medical or transcatheter therapies in the future.
authors.affiliation: Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California.
authors.forename: Tarun
authors.initials: T
authors.lastname: Chakravarty
authors.affiliation: Department of Cardiology, University Hospital, Lille, France.
authors.forename: Eric
authors.initials: E
authors.lastname: Van Belle
authors.affiliation: Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California.
authors.forename: Hasan
authors.initials: H
authors.lastname: Jilaihawi
authors.affiliation: Department of Cardiology, Mayo Clinic, Rochester, Minnesota.
authors.forename: Amit
authors.initials: A
authors.lastname: Noheria
authors.affiliation: Department of Cardiology, Clinical Institute S. Ambrogio, Milan, Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: Testa
authors.affiliation: Department of Cardiology, Clinical Institute S. Ambrogio, Milan, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Bedogni
authors.affiliation: Department of Cardiology, Karolinska University Hospital, Stockholm.
authors.forename: Andreas
authors.initials: A
authors.lastname: Rück
authors.affiliation: Department of Cardiology, University of Catania, Catania, Italy; St. Paul's Hospital, Vancouver, Canada.
authors.forename: Marco
authors.initials: M
authors.lastname: Barbanti
authors.affiliation: Luzerner Kantonsspital, Lucerne, Switzerland.
authors.forename: Stefan
authors.initials: S
authors.lastname: Toggweiler
authors.affiliation: Guys and St. Thomas' Hospital, London, United Kingdom.
authors.forename: Martyn
authors.initials: M
authors.lastname: Thomas
authors.affiliation: Guys and St. Thomas' Hospital, London, United Kingdom.
authors.forename: Muhammed Zeeshan
authors.initials: MZ
authors.lastname: Khawaja
authors.affiliation: German Heart Center, Munich, Germany.
authors.forename: Andrea
authors.initials: A
authors.lastname: Hutter
authors.affiliation: Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California.
authors.forename: Yigal
authors.initials: Y
authors.lastname: Abramowitz
authors.affiliation: Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California.
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Siegel
authors.affiliation: Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California.
authors.forename: Wen
authors.initials: W
authors.lastname: Cheng
authors.affiliation: St. Paul's Hospital, Vancouver, Canada.
authors.forename: John
authors.initials: J
authors.lastname: Webb
authors.affiliation: Columbia University Medical Center, New York-Presbyterian Hospital, New York, New York.
authors.forename: Martin B
authors.initials: MB
authors.lastname: Leon
authors.affiliation: Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California. Electronic address: makkarr@cshs.org.
authors.forename: Raj R
authors.initials: RR
authors.lastname: Makkar
mesh_terms: D001024:Aortic Valve Stenosis / Q000150:complications / Q000601:surgery*; D006328:Cardiac Catheterization; D005260:Female; D014943:Global Health; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008944:Mitral Valve Insufficiency / Q000150:complications* / Q000175:diagnosis; D011379:Prognosis; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D012720:Severity of Illness Index; D065467:Transcatheter Aortic Valve Replacement / Q000379:methods*