title: Impact of baseline mitral regurgitation on short- and long-term outcomes following transcatheter aortic valve replacement.
abstract: The prevalence of concomitant significant mitral regurgitation (MR) in patients with severe aortic stenosis (AS) undergoing transcatheter aortic valve replacement (TAVR) ranges from 2% to 33%. The impact of significant MR on post-TAVR outcomes remains controversial.
  
  
  
  The data from a cohort of patients with symptomatic severe AS undergoing TAVR at out institution were retrospectively analyzed. The last transthoracic echocardiogram (TTE) before the index TAVR procedure was selected as the baseline assessment of the degree of MR. The total study cohort (N = 589) was divided into 2 groups: significant ≥moderate MR (n = 68) versus nonsignificant <moderate MR (n = 521) at baseline. The 2 groups were compared in regard to baseline, imaging, procedural, and postprocedural characteristics. In-hospital, 30-day, and 1-year outcomes were assessed. Multivariate Cox regression survival analyses were performed to test the independent effect of ≥moderate MR on mortality at short- and long-term follow-up periods.
  
  
  
  Patients with ≥moderate MR had a higher mortality rate versus patients with <moderate MR during the initial 30-day follow-up after TAVR (unadjusted log-rank P = .011, risk-adjusted P = .031, hazard ratio = 2.40, 95% CI 1.08-5.29). However, the mortality rates at 1-year follow-up postprocedure were similar between the 2 groups (unadjusted log-rank P = .553, risk-adjusted P = .331, hazard ratio = 0.70, 95% CI 0.35-1.43). Among the original ≥moderate group, 62.5% and 77.7% of patients had improved to <moderate MR at 30-day and 1-year follow-up, respectively.
  
  
  
  Moderate or greater MR in patients undergoing TAVR is associated with a higher 30-day but not 1-year mortality. A majority of the patients demonstrated significant improvement in MR following TAVR.
authors: Section of Interventional Cardiology, MedStar Washington Hospital Center, MedStar Georgetown University Hospital, Washington, DC.
authors: Sarkis
authors: S
authors: Kiramijyan
authors: Section of Interventional Cardiology, MedStar Washington Hospital Center, MedStar Georgetown University Hospital, Washington, DC.
authors: Marco A
authors: MA
authors: Magalhaes
authors: Section of Interventional Cardiology, MedStar Washington Hospital Center, MedStar Georgetown University Hospital, Washington, DC.
authors: Edward
authors: E
authors: Koifman
authors: Section of Interventional Cardiology, MedStar Washington Hospital Center, MedStar Georgetown University Hospital, Washington, DC.
authors: Romain
authors: R
authors: Didier
authors: Section of Interventional Cardiology, MedStar Washington Hospital Center, MedStar Georgetown University Hospital, Washington, DC.
authors: Ricardo O
authors: RO
authors: Escarcega
authors: Section of Interventional Cardiology, MedStar Washington Hospital Center, MedStar Georgetown University Hospital, Washington, DC.
authors: Sa'ar
authors: S
authors: Minha
authors: Section of Interventional Cardiology, MedStar Washington Hospital Center, MedStar Georgetown University Hospital, Washington, DC.
authors: Nevin C
authors: NC
authors: Baker
authors: Section of Interventional Cardiology, MedStar Washington Hospital Center, MedStar Georgetown University Hospital, Washington, DC.
authors: Smita I
authors: SI
authors: Negi
authors: Section of Interventional Cardiology, MedStar Washington Hospital Center, MedStar Georgetown University Hospital, Washington, DC.
authors: Rebecca
authors: R
authors: Torguson
authors: Section of Interventional Cardiology, MedStar Washington Hospital Center, MedStar Georgetown University Hospital, Washington, DC.
authors: Jiaxiang
authors: J
authors: Gai
authors: Section of Interventional Cardiology, MedStar Washington Hospital Center, MedStar Georgetown University Hospital, Washington, DC.
authors: Petros
authors: P
authors: Okubagzi
authors: Section of Interventional Cardiology, MedStar Washington Hospital Center, MedStar Georgetown University Hospital, Washington, DC.
authors: Federico M
authors: FM
authors: Asch
authors: Section of Interventional Cardiology, MedStar Washington Hospital Center, MedStar Georgetown University Hospital, Washington, DC.
authors: Michael A
authors: MA
authors: Gaglia
authors: Section of Interventional Cardiology, MedStar Washington Hospital Center, MedStar Georgetown University Hospital, Washington, DC.
authors: Itsik
authors: I
authors: Ben-Dor
authors: Section of Interventional Cardiology, MedStar Washington Hospital Center, MedStar Georgetown University Hospital, Washington, DC.
authors: Lowell F
authors: LF
authors: Satler
authors: Section of Interventional Cardiology, MedStar Washington Hospital Center, MedStar Georgetown University Hospital, Washington, DC.
authors: Augusto D
authors: AD
authors: Pichard
authors: Section of Interventional Cardiology, MedStar Washington Hospital Center, MedStar Georgetown University Hospital, Washington, DC. Electronic address: ron.waksman@medstar.net.
authors: Ron
authors: R
authors: Waksman
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000601:surgery*; D015331:Cohort Studies; D015897:Comorbidity; D016208:Databases, Factual; D004452:Echocardiography; D005260:Female; D006801:Humans; D008297:Male; D008944:Mitral Valve Insufficiency / Q000000981:diagnostic imaging / Q000453:epidemiology*; D009026:Mortality; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012720:Severity of Illness Index; D016019:Survival Analysis; D065467:Transcatheter Aortic Valve Replacement; D016896:Treatment Outcome