Patients with significant mitral regurgitation (MR) after transcatheter aortic valve replacement (TAVR) face much worse outcomes, according to a new study published in JACC: Cardiovascular Interventions.
Staged interventions, the study’s authors added, may offer clinicians a chance to help those patients.
“The rapid increase in the use of TAVR over surgical aortic valve replacement, which is expected to expand into low-surgical-risk patients as well, requires a reassessment of the management strategy for patients with significant aortic stenosis and MR,” wrote lead author Guy Witberg, MD, a cardiologist at Rabin Medical Center in Israel, and colleagues. “Currently, the common practice is to perform TAVR, which in many cases will result in regression of MR as well. The main dilemma is how to manage those patients with persistent MR following isolated TAVR.”
The analysis included data from nearly 2,000 patients who received care at one of 16 TAVR facilities from 2007 to 2019. Patients with previous mitral valve surgery were excluded.
Overall, the team found that MR regressed in 44.1% of patients after TAVR, but persisted in the remaining 55.9%. Four-year mortality was higher for patients with persistent MR. Several factors were also identified that may predict when a patient will have persistent MR after TAVR: severe MR at baseline, atrial fibrillation, severe mitral annulus calcifications or mitral leaflet calcifications, a systolic pulmonary artery pressure higher than 45 mm HG, degenerative MR etiology and the use of a self-expandable valve.
Witberg et al. also examined if percutaneous edge-to-edge mitral valve repair (PMVR), “by far the most frequent mitral intervention after TAVR,” could improve outcomes for patients with persistent MR. Evaluating 91 matched pairs of patients who did or did not undergo staged PMVR—with a median time from TAVR to PMVR of 61 days—the authors found that the PMVR group did see substantial improvements in New York Heart Association functional class.
PMVR patients also saw an improvement in four-year mortality, but this difference was not statistically significant.
“Although the mortality advantage of PMVR did not reach statistical significance in the propensity score-matched analysis, this was likely due to the small sample size,” the authors wrote. However, the benefit of staged PMVR in terms of functional class through one year of follow-up was dramatic and statistically significant.”
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Michael has more than 16 years of experience as a professional writer and editor. He has written at length about cardiology, radiology, artificial intelligence and other key healthcare topics.