Impact of Concomitant Mitral Regurgitation on Cardiovascular Events and Mortality After Transcatheter Aortic Valve...

Mitral regurgitation (MR) is common in patients undergoing transcatheter aortic valve replacement (TAVR). However, it is unclear how MR severity affects prognosis. This meta-analysis evaluated the associations among baseline MR severity, cardiovascular outcomes, and mortality after TAVR. Eligible studies included adult patients undergoing TAVR with stratified MR severity (MR ≥ 2 or MR ≥ 3) and reported the post-TAVR clinical outcomes. Sensitivity analyses stratified by follow-up duration, leave-one-out sensitivity, and meta-regression were also conducted. Forty-two studies (n = 67,257 patients) were included. MR ≥ 2 was associated with increased all-cause mortality during follow-up (> 30 days) (hazard ratio [HR]: 1.40; 95% confidence interval [CI]: 1.26, 1.55) and cardiovascular mortality (risk ratio [RR]: 1.80; 95% CI: 1.05, 3.08), but not with stroke, transient ischemic attack, myocardial infarction (MI), or heart failure hospitalization. MR ≥ 3 conferred an even higher risk of all-cause mortality during follow-up (RR: 1.55; 95% CI: 1.24, 1.94) and rehospitalization (RR: 1.40; 95% CI: 1.17, 1.67), but not for stroke and MI. MR improvement occurred in 41% of patients within < 1-year post-TAVR, declined to 15% at > 1-year post-TAVR. Baseline moderate-to-severe MR (MR ≥ 2) predicts all-cause mortality during follow-up and cardiovascular mortality after TAVR, particularly severe MR (MR ≥ 3). While no consistent associations were found with nonfatal outcomes such as stroke, TIA, MI, or heart failure hospitalization, the prognostic impact of MR appears to be predominantly mortality-centered.