title: The impact of functional vs degenerative mitral regurgitation on clinical outcomes among patients undergoing transcatheter aortic valve implantation.
abstract: BACKGROUND
  Among patients undergoing transcatheter aortic valve implantation (TAVI), concomitant mitral regurgitation (MR) has been associated with adverse prognosis. We aimed to assess long-term clinical outcomes according to MR etiology.
  
  
  METHODS
  In a single-center registry of consecutive patients undergoing TAVI, we investigated the impact of functional (FMR) vs degenerative (DMR) MR on cardiovascular (CV) mortality throughout 2years of follow-up.
  
  
  RESULTS
  Among 603 patients (mean age 82.4±5.7years, 55% female) undergoing TAVI, 149 patients had moderate or severe MR (24.7%). Functional MR and DMR were documented in 53 (36%) and 96 (64%) patients, respectively. At 2years, patients with FMR and DMR had higher rates of CV mortality (30.2% vs 32.4%) as compared with patients with no MR (14.6%; FMR vs no MR: hazard ratio [HR] 2.32, 95% CI 1.34-4.02, P=.003; DMR vs no MR: HR 2.56, 95% CI 1.66-3.96, P<.001). In adjusted analyses, DMR was associated with an increased risk of CV mortality throughout the 2-year follow-up (adjusted HR 2.21, 95% CI 1.4-3.49, P=.001) as compared with FMR (adjusted HR 1.13, 95% CI 0.59-2.18, P=.707). Relevant MR was postprocedurally significantly reduced in both the DMR and FMR groups, whereas improvement of a decreased left ventricular ejection fraction was predominantly seen in the FMR group as compared with baseline.
  
  
  CONCLUSIONS
  Patients with severe, symptomatic aortic stenosis undergoing TAVI complicated by moderate or severe MR portend impaired prognosis. Particularly, patients with DMR are at increased risk for CV mortality during long-term follow-up.
authors.affiliation: Department of Cardiology, Swiss Cardiovascular Center Bern, University Hospital, Bern, Switzerland.
authors.forename: René
authors.initials: R
authors.lastname: Vollenbroich
authors.affiliation: Department of Cardiology, Swiss Cardiovascular Center Bern, University Hospital, Bern, Switzerland.
authors.forename: Stefan
authors.initials: S
authors.lastname: Stortecky
authors.affiliation: Department of Cardiology, Swiss Cardiovascular Center Bern, University Hospital, Bern, Switzerland.
authors.forename: Fabien
authors.initials: F
authors.lastname: Praz
authors.affiliation: Department of Cardiology, Swiss Cardiovascular Center Bern, University Hospital, Bern, Switzerland.
authors.forename: Jonas
authors.initials: J
authors.lastname: Lanz
authors.affiliation: Department of Cardiology, Swiss Cardiovascular Center Bern, University Hospital, Bern, Switzerland.
authors.forename: Anna
authors.initials: A
authors.lastname: Franzone
authors.affiliation: Department of Cardiovascular Surgery, Swiss Cardiovascular Center, University Hospital, Bern, Switzerland.
authors.forename: Katarzyna
authors.initials: K
authors.lastname: Zuk
authors.affiliation: Clinical Trials Unit, Department of Clinical Research, and Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland.
authors.forename: Dik
authors.initials: D
authors.lastname: Heg
authors.affiliation: Department of Cardiology, Swiss Cardiovascular Center Bern, University Hospital, Bern, Switzerland.
authors.forename: Marco
authors.initials: M
authors.lastname: Valgimigli
authors.affiliation: Department of Cardiology, Triemli Hospital, Zurich, Switzerland.
authors.forename: Crochan John
authors.initials: CJ
authors.lastname: O'Sullivan
authors.affiliation: Department of Cardiology, Hospital Interlaken, Interlaken, Switzerland.
authors.forename: Corinna
authors.initials: C
authors.lastname: Heinisch
authors.affiliation: Department of Cardiovascular Surgery, Swiss Cardiovascular Center, University Hospital, Bern, Switzerland.
authors.forename: Eva
authors.initials: E
authors.lastname: Roost
authors.affiliation: Department of Cardiology, Swiss Cardiovascular Center Bern, University Hospital, Bern, Switzerland; Department of Cardiology, Klinik im Park, Zurich, Switzerland.
authors.forename: Peter
authors.initials: P
authors.lastname: Wenaweser
authors.affiliation: Department of Cardiology, Swiss Cardiovascular Center Bern, University Hospital, Bern, Switzerland.
authors.forename: Stephan
authors.initials: S
authors.lastname: Windecker
authors.affiliation: Department of Cardiology, Swiss Cardiovascular Center Bern, University Hospital, Bern, Switzerland. Electronic address: thomas.pilgrim@insel.ch.
authors.forename: Thomas
authors.initials: T
authors.lastname: Pilgrim
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000150:complications / Q000601:surgery*; D002318:Cardiovascular Diseases / Q000401:mortality; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008944:Mitral Valve Insufficiency / Q000150:complications / Q000000981:diagnostic imaging / Q000503:physiopathology*; D016016:Proportional Hazards Models; D012042:Registries; D012720:Severity of Illness Index; D065467:Transcatheter Aortic Valve Replacement