Mitral complex geometric changes aggravate mitral stenosis after transcatheter aortic valve replacement

Area of Science:

• Cardiology
• Cardiac Surgery
• Medical Imaging

Background:

• Severe aortic stenosis (AS) frequently coexists with mitral stenosis (MS).
• Mitral stenosis (MS) aggravation post-transcatheter aortic valve replacement (TAVR) is a recognized complication with multifactorial causes.
• Geometric changes in the mitral valve complex may contribute to MS aggravation after TAVR, especially in elderly patients with small left ventricles.

Purpose of the Study:

• To investigate mitral complex geometric alterations before and after TAVR.
• To identify predictors of MS aggravation following TAVR.
• To compare TAVR with surgical aortic valve replacement (SAVR) in terms of these changes.

Main Methods:

• Retrospective analysis of adult patients undergoing TAVR or SAVR for severe AS.
• Transthoracic echocardiography to assess mitral valve area (MVA), anterior mitral valve leaflet (AMVL) angle and length, mitral annular diameter, and left ventricular (LV) size.
• Multivariate analysis to determine predictive factors for MS aggravation.

Main Results:

• A decrease in MVA index was observed post-TAVR (2.3 to 1.9 cm²).
• The angle between the AMVL and LVOT increased post-TAVR (56.3° to 67.3°).
• Smaller mitral annular diameter, restricted AMVL mobility, and implantation depth were significant predictors of MS aggravation post-TAVR.

Conclusions:

• Geometric changes in the mitral complex, including annular narrowing and restricted leaflet motion, contribute to MS aggravation after TAVR.
• Mitral annular diameter, AMVL mobility, and device implantation depth are crucial factors influencing MS outcomes post-TAVR.
• These findings highlight the importance of pre-procedural assessment of mitral valve anatomy for predicting and potentially mitigating MS aggravation after TAVR.