Impact of mitral regurgitation on clinical outcomes of patients with low-ejection fraction, low-gradient severe aortic stenosis undergoing transcatheter aortic valve implantation.

O'Sullivan, Crochan J; Stortecky, Stefan; Bütikofer, Anne; Heg, Dik; Zanchin, Thomas; Huber, Christoph; Pilgrim, Thomas; Praz, Fabien; Büllesfeld, Lutz; Khattab, Ahmed Aziz; Blöchlinger, Stefan; Carrel, Thierry; Meier, Bernhard; Zbinden, Stephan; Wenaweser, Peter Martin; Windecker, Stephan (2015). Impact of mitral regurgitation on clinical outcomes of patients with low-ejection fraction, low-gradient severe aortic stenosis undergoing transcatheter aortic valve implantation. Circulation: Cardiovascular interventions, 8(2), e001895. Lippincott Williams & Wilkins 10.1161/CIRCINTERVENTIONS.114.001895

[img]
Preview
Text
e001895.pdf - Published Version
Available under License Publisher holds Copyright.

Download (1MB) | Preview

BACKGROUND Up to 1 in 6 patients undergoing transcatheter aortic valve implantation (TAVI) present with low-ejection fraction, low-gradient (LEF-LG) severe aortic stenosis and concomitant relevant mitral regurgitation (MR) is present in 30% to 55% of these patients. The effect of MR on clinical outcomes of LEF-LG patients undergoing TAVI is unknown. METHODS AND RESULTS Of 606 consecutive patients undergoing TAVI, 113 (18.7%) patients with LEF-LG severe aortic stenosis (mean gradient ≤40 mm Hg, aortic valve area <1.0 cm(2), left ventricular ejection fraction <50%) were analyzed. LEF-LG patients were dichotomized into ≤mild MR (n=52) and ≥moderate MR (n=61). Primary end point was all-cause mortality at 1 year. No differences in mortality were observed at 30 days (P=0.76). At 1 year, LEF-LG patients with ≥moderate MR had an adjusted 3-fold higher rate of all-cause mortality (11.5% versus 38.1%; adjusted hazard ratio, 3.27 [95% confidence interval, 1.31-8.15]; P=0.011), as compared with LEF-LG patients with ≤mild MR. Mortality was mainly driven by cardiac death (adjusted hazard ratio, 4.62; P=0.005). As compared with LEF-LG patients with ≥moderate MR assigned to medical therapy, LEF-LG patients with ≥moderate MR undergoing TAVI had significantly lower all-cause mortality (hazard ratio, 0.38; 95% confidence interval, 0.019-0.75) at 1 year. CONCLUSIONS Moderate or severe MR is a strong independent predictor of late mortality in LEF-LG patients undergoing TAVI. However, LEF-LG patients assigned to medical therapy have a dismal prognosis independent of MR severity suggesting that TAVI should not be withheld from symptomatic patients with LEF-LG severe aortic stenosis even in the presence of moderate or severe MR.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Pre-clinic Human Medicine > Institute of Social and Preventive Medicine
04 Faculty of Medicine > Pre-clinic Human Medicine > CTU Bern
04 Faculty of Medicine > Department of Cardiovascular Disorders (DHGE) > Clinic of Cardiology
04 Faculty of Medicine > Department of Cardiovascular Disorders (DHGE) > Clinic of Cardiovascular Surgery

UniBE Contributor:

O'Sullivan, Crochan John; Stortecky, Stefan; Heg, Dierik Hans; Huber, Christoph; Pilgrim, Thomas; Praz, Fabien; Büllesfeld, Lutz; Khattab, Ahmed Aziz; Blöchlinger, Stefan; Carrel, Thierry; Meier, Bernhard; Zbinden, Stephan; Wenaweser, Peter Martin and Windecker, Stephan

Subjects:

600 Technology > 610 Medicine & health
300 Social sciences, sociology & anthropology > 360 Social problems & social services

ISSN:

1941-7632

Publisher:

Lippincott Williams & Wilkins

Language:

English

Submitter:

Sara Baumberger

Date Deposited:

20 Feb 2015 10:59

Last Modified:

16 Jun 2016 10:07

Publisher DOI:

10.1161/CIRCINTERVENTIONS.114.001895

PubMed ID:

25657315

Uncontrolled Keywords:

aortic valve stenosis, mitral valve insufficiency, transcatheter aortic valve implantation

BORIS DOI:

10.7892/boris.63518

URI:

https://boris.unibe.ch/id/eprint/63518

Actions (login required)

Edit item Edit item
Provide Feedback