Impact of Transcatheter Aortic Valve Implantation Among Patients With Co-existing Mild to Moderate Mitral Regurgitation.

Autor: Twing AH; Department of Medicine, University of Illinois at Chicago., Gokhale S; Division of Cardiology, Department of Medicine, Oregon and Health Science University., Slostad B; Division of Cardiology, Department of Medicine, University of Illinois at Chicago., Meyer J; Division of Cardiology, Department of Medicine, University of Illinois at Chicago., Simon E; Division of Cardiology, Department of Medicine, University of Illinois at Chicago., Dickens H; University of Illinois at Urbana-Champaign., Kaluzna SD; College of Pharmacy, University of Illinois at Chicago., Groo V; College of Pharmacy, University of Illinois at Chicago., Kansal M; Division of Cardiology, Department of Medicine, University of Illinois at Chicago., Shroff A; Division of Cardiology, Department of Medicine, University of Illinois at Chicago., Groves EM; Palo Alto Medical Foundation. Electronic address: emgroves@gmail.com.
Jazyk: angličtina
Zdroj: The American journal of cardiology [Am J Cardiol] 2022 Aug 15; Vol. 177, pp. 84-89. Date of Electronic Publication: 2022 Jun 19.
DOI: 10.1016/j.amjcard.2022.04.049
Abstrakt: A subset of patients with severe aortic stenosis (AS) who are who underwent transcatheter aortic valve implantation (TAVI) also has mitral regurgitation (MR). Clinical outcomes in these patients with combined MR and AS have varied. The purpose of this study was to assess clinical outcomes and echocardiographic outcomes after TAVI in patients with preprocedural MR. A retrospective chart review from March 2018 to June 2020 identified all TAVI patients. Patients were assigned an MR class of mild, moderate, or severe based upon pre-TAVI transthoracic echocardiogram (TTE). Patients were excluded if they were discharged from the hospital and did not have a 6-month follow-up after TAVI. Clinical outcomes at 6 months included all-cause mortality, major adverse cardiovascular events, clinically significant bleeding, changes in ejection fraction (EF) category, and changes in MR severity. Of 118 included patients (age 76 ± 10 years, 79% male, 46% White), 33% had MR, with 26% being mild and 7% moderate MR. Before TAVI, AS + MR patients were more likely to have a reduced EF (<50%) by category compared with those with AS only (33.3% vs 8.8%, p = 0.01) but were more likely to show an increase in EF by category after TAVI (19.4% vs 5.5%, p = 0.039). No significant differences were observed between the 2 groups in terms of all-cause mortality (12.8 vs 5.1%, p = 0.14), major adverse cardiovascular events (17.9 vs 8.9%, p = 0.15), or clinically significant bleeding (10.3 vs 6.3%, p = 0.45). Patients with AS and co-existing MR experienced similar clinical outcomes at 6 months to those with AS only after TAVI. They were more likely to show increases in EF category 6 months after valve implantation. Our results support the conclusion that in addition to treating the aortic valve, TAVI also potentially benefits left ventricular function in the setting of mild or moderate MR.
Competing Interests: Disclosures The authors have no conflicts of interest to declare.
(Copyright © 2022 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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