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Improved mitral valve performance after transapical aortic valve implantation
Martin Haensig1, David Michael Holzhey1, Michael Andrew Borger1
1Department of Cardiac Surgery, Heart Center of the University of Leipzig, Leipzig, Germany.
The Annals of Thoracic Surgery
|February 13, 2014
Summary
Transcatheter aortic valve implantation (TAVI) with the Edwards SAPIEN prosthesis improves mitral regurgitation (MR). Moderate/severe MR increases early mortality but does not affect long-term survival after TAVI.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Cardiac Surgery
Background:
- Concomitant mitral regurgitation (MR) is common in patients undergoing transapical aortic valve implantation (TA-AVI).
- The impact of MR on outcomes and the effect of TA-AVI on MR require further investigation.
Purpose of the Study:
- To evaluate the impact of pre-existing mitral regurgitation (MR) on patient outcomes after transapical aortic valve implantation (TA-AVI).
- To assess the efficacy of TA-AVI using the Edwards SAPIEN prosthesis in improving mitral regurgitation (MR).
Main Methods:
- A cohort of 439 patients undergoing TA-AVI between 2006 and 2011 was analyzed.
- Patients were stratified based on pre- and postoperative mitral regurgitation (MR) severity (absent, mild/trivial, moderate, severe).
- Outcomes, including in-hospital mortality and 4-year survival, were assessed using echocardiography and clinical data.
Main Results:
- Moderate/severe MR was associated with increased in-hospital mortality (adjusted HR, 3.98) but comparable 4-year survival.
- TA-AVI led to significant improvement in MR, with none of the patients having severe MR post-procedure.
- Independent predictors of MR improvement included baseline MR severity, functional MR, preserved left ventricular ejection fraction (LVEF), and mean transaortic gradient.
Conclusions:
- Moderate/severe MR before TA-AVI is linked to higher early mortality but not long-term survival.
- TA-AVI effectively improves mitral valve performance, potentially by reducing subvalvular traction and valve closure forces.
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