title: Clinical impact and evolution of mitral regurgitation following transcatheter aortic valve replacement: a meta-analysis.
abstract: OBJECTIVE
  Mitral regurgitation (MR) is a common entity in patients with aortic stenosis undergoing transcatheter aortic valve replacement (TAVR), but its influence on outcomes remains controversial. The purpose of this meta-analysis was to assess the clinical impact of and changes in significant (moderate-severe) MR in patients undergoing TAVR, overall and according to valve design (self-expandable (SEV) vs balloon-expandable (BEV)).
  
  
  METHODS
  All national registries and randomised trials were pooled using meta-analytical guidelines to establish the impact of moderate-severe MR on mortality after TAVR. Studies reporting changes in MR after TAVR on an individual level were electronically searched and used for the analysis.
  
  
  RESULTS
  Eight studies including 8015 patients (SEV: 3474 patients; BEV: 4492 patients) were included in the analysis. The overall 30-day and 1-year mortality was increased in patients with significant MR (OR 1.49, 95% CI 1.16 to 1.92; HR 1.32, 95% CI 1.12 to 1.55, respectively), but a significant heterogeneity across studies was observed (p<0.05). The impact of MR on mortality was not different between SEV and BEV in meta-regression analysis for 30-day (p=0.360) and 1-year (p=0.388) mortality. Changes in MR over time were evaluated in nine studies including 1278 patients. Moderate-severe MR (SEV: 326 patients; BEV: 192 patients) improved in 50.5% of the patients at a median follow-up of 180 (30-360) days after TAVR, and the degree of improvement was greater in patients who had received a BEV (66.7% vs 40.8% in the SEV group, p=0.001).
  
  
  CONCLUSIONS
  Concomitant moderate-severe MR was associated with increased early and late mortality following TAVR. A significant improvement in MR severity was detected in half of the patients following TAVR, and the degree of improvement was greater in those patients who had received a BEV.
authors.affiliation: Quebec Heart & Lung Institute, Quebec city, Quebec, Canada Cardiovascular Institute, Hospital Clínico San Carlos, Madrid, Spain.
authors.forename: Luis
authors.initials: L
authors.lastname: Nombela-Franco
authors.affiliation: Cardiology Department, Charles Nicolle Hospital, University of Rouen, Rouen, France.
authors.forename: Hélène
authors.initials: H
authors.lastname: Eltchaninoff
authors.affiliation: Abteilung für Kardiologie, Herzzentrum Ludwigshafen, Ludwigshafen, Germany.
authors.forename: Ralf
authors.initials: R
authors.lastname: Zahn
authors.affiliation: Cardiology Department, Instituto Clinico S. Ambrogio, Milan, Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: Testa
authors.affiliation: Columbia University Medical Center/New York-Presbyterian Hospital, New York, USA.
authors.forename: Martin B
authors.initials: MB
authors.lastname: Leon
authors.affiliation: Hospital Universitario de Santiago Compostela, A Coruña, Spain.
authors.forename: Ramiro
authors.initials: R
authors.lastname: Trillo-Nouche
authors.forename: Augusto
authors.initials: A
authors.lastname: D'Onofrio
authors.affiliation: Division of Cardiac Surgery, University of Padova, Padova, Italy.
authors.forename: Augusto
authors.initials: A
authors.lastname: D Onofrio
authors.affiliation: Columbia University Medical Center/New York-Presbyterian Hospital, New York, USA.
authors.forename: Craig R
authors.initials: CR
authors.lastname: Smith
authors.affiliation: St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: John
authors.initials: J
authors.lastname: Webb
authors.affiliation: German Heart Center, Munich, Germany.
authors.forename: Sabine
authors.initials: S
authors.lastname: Bleiziffer
authors.affiliation: Cardiology Department, Niguarda Ca' Granda Hospital, Milan, Italy.
authors.forename: Benedetta
authors.initials: B
authors.lastname: De Chiara
authors.affiliation: Department of Cardiology, La Cavale Blanche Hospital, Brest, France.
authors.forename: Martine
authors.initials: M
authors.lastname: Gilard
authors.affiliation: Ferrarotto Hospital, Catania, Italy.
authors.forename: Corrado
authors.initials: C
authors.lastname: Tamburino
authors.affiliation: Cardiology Department, Instituto Clinico S. Ambrogio, Milan, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Bedogni
authors.affiliation: Ferrarotto Hospital, Catania, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Barbanti
authors.affiliation: Department of Surgical Sciences Torino, Città della Salute e della Scienza Hospital, Molinette, Torino, Italy.
authors.forename: Stefano
authors.identifier: http://orcid.org/0000-0002-1032-9155
authors.initials: S
authors.lastname: Salizzoni
authors.affiliation: Department of Cardiology, Vall d'Hebron University Hospital, Barcelona, Spain.
authors.forename: Bruno
authors.initials: B
authors.lastname: García del Blanco
authors.affiliation: Cardiology Department, Hospital Clinic de Barcelona, IDIBAPS, Barcelona, Spain.
authors.forename: Manel
authors.initials: M
authors.lastname: Sabaté
authors.affiliation: Cardiology Department, Niguarda Ca' Granda Hospital, Milan, Italy.
authors.forename: Antonella
authors.initials: A
authors.lastname: Moreo
authors.affiliation: Cardiovascular Institute, Hospital Clínico San Carlos, Madrid, Spain.
authors.forename: Cristina
authors.initials: C
authors.lastname: Fernández
authors.affiliation: Quebec Heart & Lung Institute, Quebec city, Quebec, Canada.
authors.forename: Henrique Barbosa
authors.initials: HB
authors.lastname: Ribeiro
authors.affiliation: Quebec Heart & Lung Institute, Quebec city, Quebec, Canada.
authors.forename: Ignacio
authors.initials: I
authors.lastname: Amat-Santos
authors.affiliation: Quebec Heart & Lung Institute, Quebec city, Quebec, Canada.
authors.forename: Marina
authors.initials: M
authors.lastname: Urena
authors.affiliation: Quebec Heart & Lung Institute, Quebec city, Quebec, Canada.
authors.forename: Ricardo
authors.initials: R
authors.lastname: Allende
authors.affiliation: Cardiovascular Institute, Hospital Clínico San Carlos, Madrid, Spain.
authors.forename: Eulogio
authors.initials: E
authors.lastname: García
authors.affiliation: Cardiovascular Institute, Hospital Clínico San Carlos, Madrid, Spain.
authors.forename: Carlos
authors.initials: C
authors.lastname: Macaya
authors.affiliation: Quebec Heart & Lung Institute, Quebec city, Quebec, Canada.
authors.forename: Eric
authors.initials: E
authors.lastname: Dumont
authors.affiliation: Quebec Heart & Lung Institute, Quebec city, Quebec, Canada.
authors.forename: Philippe
authors.initials: P
authors.lastname: Pibarot
authors.affiliation: Quebec Heart & Lung Institute, Quebec city, Quebec, Canada.
authors.forename: Josep
authors.initials: J
authors.lastname: Rodés-Cabau
mesh_terms: D001024:Aortic Valve Stenosis / Q000150:complications / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D006328:Cardiac Catheterization / Q000009:adverse effects / Q000401:mortality; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D006801:Humans; D008944:Mitral Valve Insufficiency / Q000150:complications* / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology; D016017:Odds Ratio; D012307:Risk Factors; D012720:Severity of Illness Index; D016896:Treatment Outcome