Atrioventricular valve regurgitation progression after transcatheter aortic valve replacement

Background Aortic stenosis is the most frequent heart valve disease requiring intervention in the developed world. Transcatheter Aortic Valve Replacement (TAVR) is an excellent treatment modality for patients with high surgical risk or prohibitive surgical anatomy. In this population, the prevalence of multiple valvular heart disease (VHD) is high and the persistence of atrioventricular valve regurgitation (AVVR) post-procedure is associated with higher mortality. Purpose To evaluate the predictors and the extent of change in AVVR after TAVR in patients with multiple VHD. Methods A retrospective analysis of all patients who underwent TAVR until November 2024 in one tertiary care center in Portugal was conducted. VHD was diagnosed and its evolution after TAVR was documented and classified by transthoracic echocardiogram according to the current guidelines. The predictors of AVVR improvement and deterioration were derived with t-test and chi-square analysis, followed by binary logistic regression to determine the independent predictors and their potency. Results Of the 831 patients included, mitral regurgitation (MR) had a prevalence of 69.07% and tricuspid regurgitation (TR) of 71.00%. A global reduction in the burden of AVVR was noticed (FIGURE 1), with 27.68% of patients experiencing an improvement in MR and 18.77% of patients with reductions in the degree of TR. MR improvement was significantly associated with mildly reduced left ventricular ejection fraction (LVEF) (p=0.024), as well as with a lower body mass index (p=0.021), while higher values of estimated pulmonary artery pressure (ePASP) were the sole independent predictor (OR 1.017 [95% CI: 1.003-1.030], p=0.017) for MR reduction. TR improvement was found in patients with left ventricular disfunction (p=0.001 for LVEF < 50% and p=0.004 for LVEF < 40%), while non-elective TAVR was the sole independent predictor (OR 1.591 [95% CI: 1.008-2.511], p=0.046) for TR reduction. Significant paravalvular leakage was associated with worsening MR (OR 4.196 [95% CI: 1.616-10.891], p=0.003), while chronic kidney disease (OR 2.249 [95% CI: 1.140-4.435], p=0.019) and higher ePASP (OR 1.031 [CI 95% 1.009-1.053], p=0.005) were associated with worsening TR. Conclusion AVVR is prevalent but can be improved after TAVR in patients with multiple VHD. Acknowledging the risk factors for improvement and deterioration of AVVR is important to recognize which patients may be at a greater risk for worse clinical outcomes.