Transcatheter Aortic Valve Replacement and Concomitant Mitral Regurgitation

Area of Science:

• Cardiology
• Interventional Cardiology
• Cardiac Surgery

Background:

• Severe aortic stenosis often coexists with mitral regurgitation (MR).
• Moderate to severe MR in patients undergoing transcatheter aortic valve replacement (TAVR) is linked to higher risks of adverse events.
• The independent association of concomitant MR with outcomes post-TAVR is debated, and optimal management strategies are unclear.

Purpose of the Study:

• To review current literature on mitral regurgitation in the context of TAVR.
• To focus on diagnostic and therapeutic strategies for managing patients with concomitant aortic stenosis and mitral regurgitation.
• To provide insights into optimal clinical decision-making for these patients.

Main Methods:

• Literature review of diagnostic and therapeutic approaches for MR in TAVR patients.
• Analysis of current evidence regarding the impact of MR on TAVR outcomes.
• Examination of treatment strategies including TAVR alone, combined TAVR and transcatheter mitral intervention, or staged procedures.

Main Results:

• Patients with moderate to severe MR undergoing TAVR are at increased risk.
• Optimal therapeutic strategies (TAVR + HF therapy, combined TAVR + TMVI, or staged therapies) are not well-defined.
• Guideline recommendations are lacking for patients at high risk for open-heart surgery.

Conclusions:

• Individualized treatment approaches are essential, based on thorough evaluation of aortic and mitral valve anatomy/function and patient risk profiles.
• Further research is needed to clarify the independent prognostic impact of MR and to establish evidence-based guidelines for management.
• Optimal clinical decision-making requires careful consideration of diagnostic findings and therapeutic options.