Moderate or severe mitral regurgitation at baseline was associated with increased 2-year mortality after SAVR (49.8% vs 28.1%; HR 1.73) but not after TAVR (37.0% vs 32.7%; HR 1.14).
RCT (n=630)
Does preoperative moderate or severe mitral regurgitation affect 2-year mortality differently in patients undergoing TAVR versus SAVR for severe aortic stenosis?
Preoperative moderate or severe mitral regurgitation increases 2-year mortality after surgical aortic valve replacement but not after transcatheter aortic valve replacement, suggesting TAVR may be a preferable option in patients with combined aortic and mitral valve disease.
Effect estimate: adjusted HR 1.73 (95% CI 1.01-2.96)
Absolute Event Rate: 49.8% vs 28.1%
p-value: p=0.04
BACKGROUND: The effect of preoperative mitral regurgitation (MR) on clinical outcomes of patients undergoing transcatheter aortic valve replacement (TAVR) is controversial. This study sought to examine the impact of moderate and severe MR on outcomes after TAVR and surgical aortic valve replacement (SAVR). METHODS AND RESULTS: Data were drawn from the randomized Placement of Aortic Transcatheter Valve (PARTNER) Trial cohort A patients with severe, symptomatic aortic stenosis undergoing either TAVR (n=331) or SAVR (n=299). Both TAVR and SAVR patients were dichotomized according to the degree of preoperative MR (moderate/severe versus none/mild). At baseline, moderate or severe MR was reported in 65 TAVR patients (19.6%) and 63 SAVR patients (21.2%). At 30 days, among survivors who had isolated SAVR/TAVR, moderate/severe MR had improved in 25 SAVR patients (69.4%) and 30 TAVR patients (57.7%), was unchanged in 10 SAVR patients (27.8%) and 19 TAVR patients (36.5%), and worsened in 1 SAVR patient (2.8%) and 4 TAVR patients (5.8%; all P=NS). Mortality at 2 years was higher in SAVR patients with moderate or severe MR than in those with mild or less MR (49.8% versus 28.1%; adjusted hazard ratio, 1.73; 95% confidence interval, 1.01-2.96; P=0.04). In contrast, MR severity at baseline did not affect mortality in TAVR patients (37.0% versus 32.7%, moderate/severe versus none/mild; hazard ratio, 1.14; 95% confidence interval, 0.72-1.78; P=0.58; P for interaction=0.05). CONCLUSIONS: Both TAVR and SAVR were associated with a significant early improvement in MR in survivors. However, moderate or severe MR at baseline was associated with increased 2-year mortality after SAVR but not after TAVR. TAVR may be a reasonable option in selected patients with combined aortic and mitral valve disease. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT00530894.
Barbanti et al. (Thu,) conducted a rct in Severe, symptomatic aortic stenosis with preoperative mitral regurgitation (n=630). Moderate/severe mitral regurgitation vs. None/mild mitral regurgitation was evaluated on Mortality at 2 years in SAVR patients (adjusted HR 1.73, 95% CI 1.01-2.96, p=0.04). Moderate or severe mitral regurgitation at baseline was associated with increased 2-year mortality after SAVR (49.8% vs 28.1%; HR 1.73) but not after TAVR (37.0% vs 32.7%; HR 1.14).