Degenerative mitral regurgitation predicts worse outcomes in patients undergoing transcatheter aortic valve replacement
Bryan Kindya MD
Department of Medicine, Division of Internal Medicine, Emory University School of Medicine, Atlanta, Georgia
Search for more papers by this authorElisha Ouzan MD
Department of Cardiology, Hadassah Hebrew University Medical Center, Jerusalem, Israel
Search for more papers by this authorStamatios Lerakis MD
Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia
Search for more papers by this authorErhan Gonen MD
Department of Cardiology, Hadassah Hebrew University Medical Center, Jerusalem, Israel
Search for more papers by this authorVasilis Babaliaros MD
Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia
Search for more papers by this authorEren Karayel MD
Department of Cardiology, Hadassah Hebrew University Medical Center, Jerusalem, Israel
Search for more papers by this authorVinod H. Thourani MD
Department of Surgery, Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Georgia
Search for more papers by this authorIsrael Gotsman MD
Department of Cardiology, Hadassah Hebrew University Medical Center, Jerusalem, Israel
Search for more papers by this authorChandan M. Devireddy MD
Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia
Search for more papers by this authorHaim D. Danenberg MD
Department of Cardiology, Hadassah Hebrew University Medical Center, Jerusalem, Israel
Search for more papers by this authorBradley G. Leshnower MD
Department of Surgery, Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Georgia
Search for more papers by this authorRonen Beeri MD
Department of Cardiology, Hadassah Hebrew University Medical Center, Jerusalem, Israel
Search for more papers by this authorYi-An Ko PhD
Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Georgia
Search for more papers by this authorDan Gilon MD
Department of Cardiology, Hadassah Hebrew University Medical Center, Jerusalem, Israel
Search for more papers by this authorHina Ahmed MPH
Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia
Search for more papers by this authorChang Liu MPH
Emory Clinical Cardiovascular Research Institute, Atlanta, Georgia
Search for more papers by this authorChaim Lotan MD
Department of Cardiology, Hadassah Hebrew University Medical Center, Jerusalem, Israel
Search for more papers by this authorCorresponding Author
Kreton Mavromatis MD
Department of Medicine, Atlanta VA Medical Center, Atlanta, Georgia
Correspondence Kreton Mavromatis, MD, Department of Medicine, Atlanta VA Medical Center, 1670 Clairmont Road, 111B, Atlanta GA 30033. Email: [email protected]Search for more papers by this authorBryan Kindya MD
Department of Medicine, Division of Internal Medicine, Emory University School of Medicine, Atlanta, Georgia
Search for more papers by this authorElisha Ouzan MD
Department of Cardiology, Hadassah Hebrew University Medical Center, Jerusalem, Israel
Search for more papers by this authorStamatios Lerakis MD
Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia
Search for more papers by this authorErhan Gonen MD
Department of Cardiology, Hadassah Hebrew University Medical Center, Jerusalem, Israel
Search for more papers by this authorVasilis Babaliaros MD
Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia
Search for more papers by this authorEren Karayel MD
Department of Cardiology, Hadassah Hebrew University Medical Center, Jerusalem, Israel
Search for more papers by this authorVinod H. Thourani MD
Department of Surgery, Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Georgia
Search for more papers by this authorIsrael Gotsman MD
Department of Cardiology, Hadassah Hebrew University Medical Center, Jerusalem, Israel
Search for more papers by this authorChandan M. Devireddy MD
Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia
Search for more papers by this authorHaim D. Danenberg MD
Department of Cardiology, Hadassah Hebrew University Medical Center, Jerusalem, Israel
Search for more papers by this authorBradley G. Leshnower MD
Department of Surgery, Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Georgia
Search for more papers by this authorRonen Beeri MD
Department of Cardiology, Hadassah Hebrew University Medical Center, Jerusalem, Israel
Search for more papers by this authorYi-An Ko PhD
Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Georgia
Search for more papers by this authorDan Gilon MD
Department of Cardiology, Hadassah Hebrew University Medical Center, Jerusalem, Israel
Search for more papers by this authorHina Ahmed MPH
Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia
Search for more papers by this authorChang Liu MPH
Emory Clinical Cardiovascular Research Institute, Atlanta, Georgia
Search for more papers by this authorChaim Lotan MD
Department of Cardiology, Hadassah Hebrew University Medical Center, Jerusalem, Israel
Search for more papers by this authorCorresponding Author
Kreton Mavromatis MD
Department of Medicine, Atlanta VA Medical Center, Atlanta, Georgia
Correspondence Kreton Mavromatis, MD, Department of Medicine, Atlanta VA Medical Center, 1670 Clairmont Road, 111B, Atlanta GA 30033. Email: [email protected]Search for more papers by this authorAbstract
Objectives
To evaluate the role mitral regurgitation (MR) etiology and severity play in outcomes for patients undergoing transcatheter aortic valve replacement (TAVR).
Background
Multiple prior studies have investigated the influence of MR severity on outcomes for patients undergoing TAVR. Less has been published regarding the effects of MR etiology on outcomes, including its impact on heart failure hospitalization.
Methods
Two hundred and seventy patients undergoing TAVR at 2 hospitals were enrolled. Each patient had a baseline and follow-up (within 30 days of TAVR) echocardiogram that was analyzed. MR was graded as none, mild, moderate, or severe, as well as functional or degenerative. We compared patient outcomes, including death and heart failure hospitalization, among none-mild MR, moderate-severe functional MR, and moderate-severe degenerative MR groups.
Results
Two hundred and seventy patients underwent TAVR, reducing mean aortic valve gradients from 45 ± 15 mm Hg to 9 ± 4 mm Hg. On multivariable analysis, only patients with moderate-severe degenerative MR had decreased survival free of death or CHF hospitalization compared to those with none-mild MR (P = .011). Subanalysis showed patients with moderate-severe degenerative MR were more likely to be hospitalized for heart failure at 2 years compared to those with moderate-severe functional MR (P = .02). Patients with moderate-severe degenerative MR were also less likely to have improvement in MR severity at follow up (P = .01).
Conclusions
Special consideration should be given to patients with moderate-severe degenerative MR undergoing TAVR. As transcatheter approaches for mitral valve repair and replacement continue to evolve, moderate-severe degenerative MR patients may benefit from consideration of double valve intervention.
Supporting Information
Additional Supporting Information may be found online in the supporting information tab for this article.
| Filename | Description |
|---|---|
| ccd27607-sup-0001-suppinfoTab1.docx14.9 KB | Supporting Information Table 1 |
| ccd27607-sup-0002-suppinfoFig1.tif32.9 KB | Supporting Information Figure 1 |
| ccd27607-sup-0003-suppinfoFig2.tif67.8 KB | Supporting Information Figure 1 |
Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.
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