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The impact of moderate Aortic Valve Disease in patients undergoing MitraClip for severe MR

Haitham Saleh Ali Al-Hindwan1, Günther Silbernagel1, Jonathan Curio1

  • 1Department of Cardiology, Charité Berlin, Campus Benjamin Franklin, Berlin, Germany.

Clinical Hemorheology and Microcirculation
|May 12, 2020
PubMed
Abstract

Insights

Transcatheter mitral valve repair with MitraClip in patients with severe mitral regurgitation (MR) and moderate aortic valve disease showed that concomitant aortic regurgitation (AR) significantly increased mortality. Aortic stenosis (AS) did not impact mortality but was linked to residual MR.

Area of Science:

  • Cardiovascular Medicine
  • Interventional Cardiology
  • Heart Valve Disease

Background:

  • High-risk patients with severe mitral regurgitation (MR) and coexisting aortic valve disease pose complex management challenges.
  • Transcatheter interventions like MitraClip offer alternatives for severe MR in patients with prohibitive surgical risk.
  • Optimal strategies for managing concomitant aortic valve disease during transcatheter mitral valve repair are not well-established.

Purpose of the Study:

  • To investigate the impact of moderate aortic valve disease (stenosis or regurgitation) on outcomes after MitraClip for severe MR.
  • To compare procedural success, mortality, and heart failure hospitalizations in patients with and without concomitant moderate aortic valve disease.

Main Methods:

  • Retrospective single-center study of 286 MitraClip procedures.
  • Patients were categorized based on the presence of moderate aortic stenosis (AS) or moderate aortic regurgitation (AR).
  • Outcomes analyzed included residual MR, all-cause death, and heart failure hospitalizations at 1-year follow-up.

Main Results:

  • Concomitant moderate AS was associated with a higher incidence of residual MR (>moderate) post-MitraClip compared to no aortic valve disease (14.3% vs. 8.9%, p=0.001).
  • No significant difference was observed in the combined endpoint of all-cause death and heart failure hospitalizations at 1 year between groups.
  • Mortality was significantly higher in patients with moderate AR compared to those without aortic valve disease or with moderate AS (17.9% vs. 3.8% vs. 5%, p=0.006).

Conclusions:

  • Coincidental moderate aortic stenosis may lead to suboptimal technical results with increased residual MR after MitraClip.
  • While overall mortality and heart failure hospitalizations were comparable at 1 year, moderate AR was linked to significantly higher mortality.
  • Larger trials are needed to confirm these hypothesis-generating findings due to the limited patient numbers.
Keywords:
MitraClipMitral valve regurgitationTAVIaortic valve regurgitationaortic valve stenosisinterventional mitral valve repair

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