Mitral Regurgitation after TAVR: Sex Differences and Low-Flow Low-Gradient Aortic Stenosis

Moderate or severe mitral regurgitation (MR) is common in patients with severe aortic stenosis (AS) treated with transcatheter aortic valve replacement (TAVR).

The objectives of the study was to help define the prevalence and prognosis of persistent MR post-TAVR, particularly in women and in low-flow low-gradient (LFLG) AS.

In this single-center, observational study, 344 consecutive TAVR patients with severe AS and moderate or greater MR pre-TAVR were identified. Patients were stratified by AS subtype (classic vs LFLG). Factors associated with MR improvement to mild or less were evaluated using multivariable logistic regression. Survival was analyzed with Cox proportional hazards models adjusted for clinical and echocardiographic covariates.

The mean age was 81.9 years, 48.5% were females, and 45.1% had LFLG AS. MR improved by ≥1 grade in 62.8% and to mild or less in 52.9% of patients, with similar rates in classic vs LFLG AS. On multivariable analysis, severe (vs moderate) baseline MR, hypertension, and female sex were independently associated with lower odds of MR improvement to mild or less. In LFLG AS, female sex and severe MR remained significant predictors of persistent MR, whereas a higher pre-TAVR aortic valve mean gradient was associated with improved MR. Residual severe MR was associated with increased mortality, driven by those with LFLG AS.

More than half of TAVR patients with moderate or severe MR experience MR improvement post-TAVR. Women and those with severe MR are less likely to have a significant improvement in MR. Patients with LFLG AS and persistent moderate or severe MR have worse survival post-TAVR.