title: The beneficial effects of TAVI in mitral insufficiency.
abstract: BACKGROUND
  Previous studies have suggested that concomitant mitral regurgitation (MR) is a risk factor for acute transcatheter aortic valve implantation (TAVI) failure, but may improve afterwards. Aim of this study was to assess the prevalence, clinical meaning and modifications of MR in patients undergoing TAVI.
  
  
  METHODS
  In a retrospective, two-center (Potenza-San Carlo and Roma- San Camillo) study, from January 2010 to June 2014 we enrolled 165 consecutive patients (age =80 ± 5 years, 74 males, Ejection Fraction 51 ± 9 %) referred for TAVI with either Medtronic Core-ReValving System (in 114 patients, 69%) or balloon-expandable Edwards SAPIEN/SAPIEN XT (in 51 patients, 31%). All patients underwent TTE and TEE assessment of MR (from 1, mild to 4 = severe according to ESC latest guidelines) with core lab reading by a single observer blinded to patient identity and status. Assessment was performed at baseline (24 h prior to intervention) and at 1, 6, 12 and 24 months.
  
  
  RESULTS
  Mild-to-Moderate MR (grade 1-2) was present in 137 patients and Moderate-to-Severe MR (grade 3-4) was present in 28 patients. No significant differences were seen comparing perioperative mortality and morbidity between the two groups. In the group of preoperative MR grade 3-4 the mean decrease from MR pre-TAVI to MR at 1 month post-TAVI was 0.464 (p < 0.0001) and this improvement was persistent at 6 months (p < 0.0001) and at 12 months (p < 0.0001), with partial benefit loss at 1 and 2 years. The mean difference from Left Atrial volume post-TAVI at 1 month was 16.5 ml (p < 0.0001) and this improvement was persistent at 12 months 12.12 ml (p < 0.0001).
  
  
  CONCLUSIONS
  TAVI effectively treats the aortic valve but as a beneficial by product also ameliorates concomitant MR. The presence of moderate-to-severe MR does not increase the acute risk of failure of TAVI. In successful procedures, the MR improves immediately and persistently.
authors.affiliation: Cardiology Intensive Care Unit "Alta Specialità del Cuore" Department AORN San Carlo Hospital Potenza, Via Potito Petrone, 85100, Potenza, Italy. marcofabiocostatino@tiscali.it.
authors.forename: Marco Fabio
authors.initials: MF
authors.lastname: Costantino
authors.affiliation: UO Emergency Care, San Giovanni di Dio Hospital Melfi -ASP, Potenza, Italy.
authors.forename: Ernesta
authors.initials: E
authors.lastname: Dores
authors.affiliation: UO Cardiology Intensive Care Unit, Villa d'Agri Hospital -ASP, Potenza, Italy.
authors.forename: Pasquale
authors.initials: P
authors.lastname: Innelli
authors.affiliation: Cardiology Intensive Care Unit "Alta Specialità del Cuore" Department AORN San Carlo Hospital Potenza, Via Potito Petrone, 85100, Potenza, Italy.
authors.forename: Antonella
authors.initials: A
authors.lastname: Matera
authors.affiliation: Cardiology Intensive Care Unit "Alta Specialità del Cuore" Department AORN San Carlo Hospital Potenza, Via Potito Petrone, 85100, Potenza, Italy.
authors.forename: Vincenza
authors.initials: V
authors.lastname: Santillo
authors.affiliation: UO Interventional Cardiology Unit, S. Camillo Forlanini Hospital, Rome, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Violini
authors.affiliation: UO Interventional Cardiology Unit, S. Camillo Forlanini Hospital, Rome, Italy.
authors.forename: Rosario
authors.initials: R
authors.lastname: Fiorilli
authors.affiliation: UO Cardiac Surgery ,Ospedale di Circolo, Università dell'Insubria, Varese, Italy.
authors.forename: GianGiuseppe
authors.initials: G
authors.lastname: Cappabianca
authors.affiliation: UO Cardiac Surgery, Università di BARI, Bari, Italy.
authors.forename: Nicola
authors.initials: N
authors.lastname: Marraudino
authors.affiliation: Institute of clinical physiology, CNR, Pisa, Italy.
authors.forename: Eugenio
authors.initials: E
authors.lastname: Picano
authors.affiliation: Cardiology Intensive Care Unit "Alta Specialità del Cuore" Department AORN San Carlo Hospital Potenza, Via Potito Petrone, 85100, Potenza, Italy.
authors.forename: Giandomenico
authors.initials: G
authors.lastname: Tarsia
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000601:surgery*; D001024:Aortic Valve Stenosis / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D004452:Echocardiography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007558:Italy / Q000453:epidemiology; D008297:Male; D008944:Mitral Valve Insufficiency / Q000150:complications* / Q000175:diagnosis / Q000453:epidemiology; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*; D012720:Severity of Illness Index; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D065467:Transcatheter Aortic Valve Replacement / Q000379:methods*; D016896:Treatment Outcome