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High baseline MR linked to mortality after TAVR
Severe baseline mitral regurgitation was associated with a twofold increased risk for mortality after transcatheter aortic valve replacement compared with mild or no mitral regurgitation in a recent study published in Circulation.
The aim of the multicenter registry study was to investigate the prognostic significance of mitral regurgitation (MR) on TAVR, the effect of TAVR on the severity of MR and variables that may improve MR in the post-TAVR setting.
The analysis included 1,007 consecutive participants who had undergone TAVR with the CoreValve ReValving system (Medtronic).
More than half of the cohort (66.5%) presented with no or mild MR. Moderate MR was reported in 24.1% and severe MR was reported in 9.3%.
Those with severe or moderate MR experienced similar mortality rates (OR=1.1; P=.2) 1 month after TAVR. Also at this time point, compared with no or mild MR, severe MR (OR=2.2; P<.001) and moderate MR (OR=1.9; P=.02) yielded significantly higher mortality rates.
At 1 year, patients with severe or moderate MR had comparable mortality rates (HR=1.4; P=.06). Similar to the 1-month comparison, 1-year results indicated that severe MR (HR=1.7; P<.001) and moderate MR (HR=1.4; P=.03) were associated with significantly higher mortality than no or mild MR.
Mortality at 1 year also was predicted by severe pulmonary hypertension, atrial fibrillation and MR more severe than mild. An improvement of at least one grade in MR severity did not predict 1-year mortality.
Forty-seven percent of severe MR patients and 35% of those in the moderate group demonstrated improvement at 1 year.
Independent predictors of MR severity improvement included a functional etiology of MR, the absence of severe pulmonary hypertension and AF.
Disclosure: Four researchers reported being TAVR medical proctors at Medtronic. One researcher serves on the Medtronic advisory board.