Long-Term Impact of Multivalvular Heart Disease in Patients Undergoing Transcatheter Aortic Valve Replacement

Multivalvular heart disease (MVHD) is frequently encountered in patients undergoing transcatheter aortic valve replacement (TAVR). However, the long-term prognostic impact of MVHD in this population remains poorly characterised. The aim of this study was to evaluate the long-term clinical outcomes and echocardiographic evolution of MVHD after TAVR.

A total of 1918 consecutive patients with severe symptomatic aortic stenosis (AS) undergoing TAVR were included. MVHD was defined as the presence of moderate or greater mitral (MR) or tricuspid (TR) regurgitation before the procedure. Baseline, procedural, and follow-up data (median 4.0 years, interquartile range 2.8-5.2 years) were prospectively collected. Changes in MR and TR severity were assessed from baseline to the last available echocardiography evaluation.

A total of 450 patients (23.5%) had MVHD at baseline. The presence of MVHD was associated with an increased all-cause mortality (adjusted hazard ratio [HR] 1.21, 95% confidence interval [CI] 1.04-1.40; P = 0.011) and cardiovascular mortality (adjusted HR 1.29, 95% CI 1.04-1.61; P = 0.018) at follow-up. After adjustment, only baseline moderate or greater TR remained independently associated with all-cause mortality (HR 1.38, 95% CI 1.04-1.84; P = 0.027). At discharge, MR improved in 181 patients (40.2%), with similar rates across MR mechanisms (P = 0.582), and TR improved in 71 (15.8%). MVHD improvement was sustained over time, whereas the absence of recovery was associated with a higher risk of all-cause mortality and cardiovascular mortality up to 6 years.

Patients with MVHD exhibit worse long-term outcomes after TAVR. Although TAVR provided sustained improvement of concomitant valvular lesions in about one-half of patients, lack of recovery at discharge predicted poorer long-term survival, highlighting the need for comprehensive baseline assessment and close echocardiographic follow-up in this high risk population.