Natural History of Mitral Regurgitation After Transcatheter Aortic Valve Implantation

Background: This study sought to determine the impact of mitral regurgitation (MR) on outcomes after transcatheter aortic valve implantation (TAVI).

Methods: This was an observational study of TAVI for aortic stenosis (AS) from November 2012 to December 2021; 25% of patients were excluded because post-TAVI echocardiograms were unavailable. Excluded patients had a higher Society of Thoracic Surgeons predicted risk of mortality score than included patients (5.6% vs 4.9%). Patients were dichotomized according to the severity of pre-TAVI MR: < moderate vs ≥ moderate.

Results: A total of 2250 patients underwent TAVI, of whom 329 (14.6%) had MR ≥ moderate before TAVI. Baseline MR ≥ moderate was associated with reduced survival (46.2% for MR ≥ moderate vs 58.7% for MR < moderate; P < .001) and a higher incidence of heart failure readmission at 5 years after TAVI; 11% of patients had progression or persistence of MR ≥ moderate at 1 year after TAVI, which was also associated with reduced survival. On multivariable logistic regression, increasing age, women, lower ejection fraction, prior acute coronary syndrome, concomitant aortic insufficiency ≥ moderate, low-flow low-gradient AS, pulmonary hypertension, baseline tricuspid regurgitation ≥ moderate, and lower mean pre-TAVI aortic transvalvular pressure gradient were associated with progression or persistence of MR ≥ moderate at 1 year after TAVI, whereas procedural variables and postprocedural complications were not.

Conclusions: Significant MR before and after TAVI was associated with reduced survival. Whereas various clinical variables were associated with significant MR after TAVI, periprocedural variables were not. Evolution of MR must be carefully surveilled after TAVI, and more data are needed to establish guidelines for managing mixed AS and MR.