The change of mitral regurgitation severity after transfemoral vs. transapical trans-catheter aortic valve implantation (TAVI)

Markus Mach, David Santer, Harald Pisarik, Gabriel Weiss, Martin Grabenwöger

Hospital Hietzing, Department of Cardiovascular Surgery, Vienna, Austria

Date, time and location: 2018.05.27 10:30, Congress Hall, 2F–C

Abstract

Background:

Mitral regurgitation (MR) is a frequent comorbidity in patients with severe aortic stenosis undergoing transcatheter aortic valve implantation. The objective of this study is to find determinants associated with MR improvement.

Methods:

MR changes were assessed in 228 patients before and after TAVI by comparing transthoracic echocardiography. MR was assessed by visual inspection and color-flow Doppler.  The transapical (TA) access route had been chosen in case of severe kinking or calcification of the iliac vessels.

Results:

After the procedure, the number of patients suffering from MR was significantly reduced from 90.4% to 62.6% (p<0.001) in the transfemoral (TF) TAVI population. For patients within the transapical (TA) cohort a significant drop from 87.6% to 53.4% (p<0.001) had been observed. More than half of the patients (48.2%) with severe or moderate had improved in the TF-cohort vs. 67.3% in the TA-cohort (p=0.032).  Patients with improved MR were less likely to have diabetes, a history of myocardial infarction, coronary artery disease and normal LVEF.

No significant differences were shown between both groups concerning the post-procedural complications defined according the VARC-2 Criteria and the 30-day mortality. Even though all patients showed significant improvement in NYHA class post implant, patients with moderate and severe MR featured less improvement (p=0.036) and had a lower long term survival (log rank p=0.033).

Conclusion:

A significant improvement of MR after TAVI could be shown in this study, especially among patients with severe MR. Preoperative moderate/severe MR as common comorbidity in patients referred for TAVI procedure is associated with a lower long-term survival rate and less improvement in NYHA class and therefore characterizes a high risk population. These findings however, have to be confirmed in a larger multi-center study.