The impact of functional vs degenerative mitral regurgitation on clinical outcomes among patients undergoing transcatheter aortic valve implantation.

Vollenbroich, René; Stortecky, Stefan; Praz, Fabien; Lanz, Jonas; Franzone, Anna; Zuk, Katarzyna; Heg, Dik; Valgimigli, Marco; O'Sullivan, Crochan John; Heinisch, Corinna; Roost, Eva; Wenaweser, Peter Martin; Windecker, Stephan; Pilgrim, Thomas (2017). The impact of functional vs degenerative mitral regurgitation on clinical outcomes among patients undergoing transcatheter aortic valve implantation. American Heart Journal, 184, pp. 71-80. Elsevier 10.1016/j.ahj.2016.10.015

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BACKGROUND Among patients undergoing transcatheter aortic valve implantation (TAVI), concomitant mitral regurgitation (MR) has been associated with adverse prognosis. We aimed to assess long-term clinical outcomes according to MR etiology. METHODS In a single-center registry of consecutive patients undergoing TAVI, we investigated the impact of functional (FMR) vs degenerative (DMR) MR on cardiovascular (CV) mortality throughout 2years of follow-up. RESULTS Among 603 patients (mean age 82.4±5.7years, 55% female) undergoing TAVI, 149 patients had moderate or severe MR (24.7%). Functional MR and DMR were documented in 53 (36%) and 96 (64%) patients, respectively. At 2years, patients with FMR and DMR had higher rates of CV mortality (30.2% vs 32.4%) as compared with patients with no MR (14.6%; FMR vs no MR: hazard ratio [HR] 2.32, 95% CI 1.34-4.02, P=.003; DMR vs no MR: HR 2.56, 95% CI 1.66-3.96, P<.001). In adjusted analyses, DMR was associated with an increased risk of CV mortality throughout the 2-year follow-up (adjusted HR 2.21, 95% CI 1.4-3.49, P=.001) as compared with FMR (adjusted HR 1.13, 95% CI 0.59-2.18, P=.707). Relevant MR was postprocedurally significantly reduced in both the DMR and FMR groups, whereas improvement of a decreased left ventricular ejection fraction was predominantly seen in the FMR group as compared with baseline. CONCLUSION Patients with severe, symptomatic aortic stenosis undergoing TAVI complicated by moderate or severe MR portend impaired prognosis. Particularly, patients with DMR are at increased risk for CV mortality during long-term follow-up.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Cardiovascular Disorders (DHGE) > Clinic of Cardiovascular Surgery
04 Faculty of Medicine > Department of Cardiovascular Disorders (DHGE) > Clinic of Cardiology

UniBE Contributor:

Vollenbroich, René; Stortecky, Stefan; Praz, Fabien; Lanz, Jonas; Franzone, Anna; Zuk, Katarzyna; Valgimigli, Marco; O'Sullivan, Crochan John; Heinisch, Corinna; Roost, Eva; Wenaweser, Peter Martin; Windecker, Stephan and Pilgrim, Thomas

Subjects:

600 Technology > 610 Medicine & health

ISSN:

0002-8703

Publisher:

Elsevier

Language:

English

Submitter:

Judith Liniger

Date Deposited:

28 Dec 2016 14:47

Last Modified:

15 Sep 2017 10:16

Publisher DOI:

10.1016/j.ahj.2016.10.015

PubMed ID:

27892889

BORIS DOI:

10.7892/boris.91065

URI:

https://boris.unibe.ch/id/eprint/91065

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