Witberg, Guy, Codner, Pablo, Landes, Uri, Schwartzenberg, Shmuel, Barbanti, Marco, Valvo, Roberto ORCID: 0000-0002-7084-188X, De Backer, Ole, Ooms, Joris F., Islas, Fabian, Marroquin, Luis, Sedaghat, Alexander, Sugiura, Atsushi, Masiero, Giulia, Werner, Paul, Armario, Xavier ORCID: 0000-0002-4662-0251, Fiorina, Claudia, Arzamendi, Dabit, Santos-Martinez, Sandra, Fernandez-Vazquez, Felipe, Baz, Jose A., Steblovnik, Klemen, Mauri, Victor, Adam, Matti, Merdler, Ilan, Hein, Manuel, Ruile, Philipp, Grasso, Carmelo, Branca, Luca, Estevez-Loureiro, Rodrigo, Benito-Gonzalez, Tomas, Amat-Santos, Ignacio J., Mylotte, Darren, Andreas, Martin, Bunc, Matjaz, Tarantini, Giuseppe, Sinning, Jan-Malte, Nombela-Franco, Luis ORCID: 0000-0003-3438-8907, Sondergaard, Lars, Van Mieghem, Nicolas M., Finkelstein, Ariel and Kornowski, Ran (2021). Effect of Transcatheter Aortic Valve Replacement on Concomitant Mitral Regurgitation and Its Impact on Mortality. JACC-Cardiovasc. Interv., 14 (11). S. 1181 - 1193. NEW YORK: ELSEVIER SCIENCE INC. ISSN 1876-7605

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Abstract

OBJECTIVES The purpose of this study was to examine the impact of residual mitral regurgitation (MR) on mortality in patients undergoing transcatheter aortic valve replacement (TAVR). BACKGROUND MR is common in patients undergoing TAVR. Data on optimal management of patients with significant MR after TAVR are limited. METHODS The registry consisted of 16 TAVR centers (n = 7,303). Outcomes of patients with $ moderate versus lesser grade MR after TAVR were compared. RESULTS In 1,983 (27.2%) patients, baseline MR grade was $ moderate. MR regressed in 874 (44.1%) patients and persisted in 1,109 (55.9%) after TAVR. Four-year mortality was higher for those with MR persistence, but not for those with MR regression after TAVR, compared with nonsignificant baseline MR (43.8% vs. 35.1% vs. 32.4%; hazard ratio [HR]: 1.38; p = 0.008; HR: 1.02; p = 0.383, respectively). New York Heart Association functional class III to IV after TAVR was more common in those with MR persistence vs. regression (14.4% vs. 3.9%; p < 0.001). In a propensity score-matched cohort (91 patients' pairs), with significant residual MR after TAVR who did or did not undergo staged mitral intervention, staged intervention was associated with a better functional class through 1 year of follow-up (82.4% vs. 33.3% New York Heart Association functional class I or II; p < 0.001), and a numerically lower 4-year mortality, which was not statistically significant (64.6% vs. 37.5%; HR: 1.66; p = 0.097). CONCLUSIONS Risk stratification based on improvement in MR and symptoms after TAVR can identify patients at increased mortality risk after TAVR. These patients may benefit from a staged transcatheter mitral intervention, but this requires further proof from future studies. (C) 2021 by the American College of Cardiology Foundation.

Item Type: Journal Article
Creators:
CreatorsEmailORCIDORCID Put Code
Witberg, GuyUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Codner, PabloUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Landes, UriUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Schwartzenberg, ShmuelUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Barbanti, MarcoUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Valvo, RobertoUNSPECIFIEDorcid.org/0000-0002-7084-188XUNSPECIFIED
De Backer, OleUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Ooms, Joris F.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Islas, FabianUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Marroquin, LuisUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Sedaghat, AlexanderUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Sugiura, AtsushiUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Masiero, GiuliaUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Werner, PaulUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Armario, XavierUNSPECIFIEDorcid.org/0000-0002-4662-0251UNSPECIFIED
Fiorina, ClaudiaUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Arzamendi, DabitUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Santos-Martinez, SandraUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Fernandez-Vazquez, FelipeUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Baz, Jose A.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Steblovnik, KlemenUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Mauri, VictorUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Adam, MattiUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Merdler, IlanUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Hein, ManuelUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Ruile, PhilippUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Grasso, CarmeloUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Branca, LucaUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Estevez-Loureiro, RodrigoUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Benito-Gonzalez, TomasUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Amat-Santos, Ignacio J.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Mylotte, DarrenUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Andreas, MartinUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Bunc, MatjazUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Tarantini, GiuseppeUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Sinning, Jan-MalteUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Nombela-Franco, LuisUNSPECIFIEDorcid.org/0000-0003-3438-8907UNSPECIFIED
Sondergaard, LarsUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Van Mieghem, Nicolas M.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Finkelstein, ArielUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Kornowski, RanUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
URN: urn:nbn:de:hbz:38-605366
DOI: 10.1016/j.jcin.2021.02.030
Journal or Publication Title: JACC-Cardiovasc. Interv.
Volume: 14
Number: 11
Page Range: S. 1181 - 1193
Date: 2021
Publisher: ELSEVIER SCIENCE INC
Place of Publication: NEW YORK
ISSN: 1876-7605
Language: English
Faculty: Unspecified
Divisions: Unspecified
Subjects: no entry
Uncontrolled Keywords:
KeywordsLanguage
COREVALVE REVALVING SYSTEM; IMPLANTATION; SOCIETYMultiple languages
Cardiac & Cardiovascular SystemsMultiple languages
URI: http://kups.ub.uni-koeln.de/id/eprint/60536

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