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Coexisting Mitral Regurgitation Impairs Survival After Transcatheter Aortic Valve Implantation

Hisato Takagi1, Takuya Umemoto1,

  • 1Department of Cardiovascular Surgery, Shizuoka Medical Center, Shizuoka, Japan.

The Annals of Thoracic Surgery
|August 17, 2015
PubMed
Abstract

Insights

Untreated mitral regurgitation (MR) significantly increases mortality risk after transcatheter aortic valve implantation (TAVI) for aortic stenosis (AS). This meta-analysis confirms apparent MR is linked to higher early and overall death rates post-TAVI.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Cardiac Surgery

Background:

  • Coexisting mitral regurgitation (MR) impact on survival post-transcatheter aortic valve implantation (TAVI) for aortic stenosis (AS) is unclear.
  • Existing evidence on MR and TAVI outcomes is limited.
  • A comprehensive analysis of adjusted observational studies is needed.

Purpose of the Study:

  • To conduct the first meta-analysis on the association between untreated MR and mortality after TAVI for AS.
  • To summarize contemporary evidence from adjusted observational studies.
  • To evaluate the impact of different grades of MR on post-TAVI survival.

Main Methods:

  • Systematic search of MEDLINE and EMBASE databases up to February 2015.
  • Inclusion of observational studies reporting adjusted hazard ratios (HRs) or odds ratios (ORs) for mortality.
  • Analysis of early (30-day/in-hospital) and overall all-cause mortality in patients with apparent versus unapparent MR.

Main Results:

  • Sixteen studies with 13,672 patients were included.
  • Apparent MR was associated with a significant increase in early mortality (OR 2.17; 95% CI 1.50-3.14).
  • Apparent MR also significantly increased overall all-cause mortality (HR 1.81; 95% CI 1.37-2.40).

Conclusions:

  • Coexisting and untreated apparent MR (moderate to severe) is linked to increased early and overall mortality after TAVI for AS.
  • Findings highlight the importance of addressing MR in AS patients undergoing TAVI.
  • Further research may be warranted to explore management strategies for MR in this population.

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