Key result
Mixed aortic valve disease in TAVR linked to ~106% higher PVR risk versus isolated AS.
Why the study?
Mixed aortic valve disease represents a more complex cohort than isolated aortic stenosis, but limited data are available regarding long-term outcomes after TAVR.
Does mixed aortic valve disease increase the risk of paravalvular regurgitation and long-term mortality compared to isolated aortic stenosis in patients undergoing TAVR?
Cohort (n=880)
No
Does mixed aortic valve disease increase the risk of paravalvular regurgitation and long-term mortality compared to isolated aortic stenosis in patients undergoing TAVR?
Effect estimate: OR 2.06 (95% CI 1.51-2.81)
p-value: p=<0.001
In patients undergoing TAVR, the presence of mixed aortic valve disease is associated with a higher risk of paravalvular regurgitation and worse long-term survival compared to isolated severe aortic stenosis.
May warrant closer PVR monitoring after TAVR in mixed aortic valve disease; observational data leave open whether this alters selection or technique.
AIMS: Transcatheter aortic valve replacement (TAVR) revolutionized the therapy of severe aortic stenosis (AS) with rising numbers. Mixed aortic valve disease (MAVD) treated by TAVR is gaining more interest, as those patients represent a more complex cohort as compared with isolated AS. However, concerning long-term outcome for this cohort only, limited data are available. The aim of the study is to assess the prevalence of MAVD in TAVR patients, investigate its association with paravalvular regurgitation (PVR), and analyse its impact on long-term mortality after TAVR. METHODS AND RESULTS: We conducted a registry-based cohort study using the Vienna TAVR registry, enrolling patients who underwent TAVR at Medical University of Vienna between January 2007 and May 2020 with available transthoracic echocardiography before and after TAVR (n = 880). Data analysis included PVR incidence and long-term survival outcomes. A total of 647 (73.52%) out of 880 patients had ≥ mild aortic regurgitation next to severe AS. MAVD was associated with PVR compared with isolated AS with an odds ratio of 2.06, 95% confidence interval (CI): 1.51-2.81 (P = <0.001). More than mild PVR after TAVR (n = 168 out of 880: 19.09%) was related to higher mortality compared with the absence of PVR with a hazard ratio (HR) of 1.33, 95% CI: 1.05- 1.67 (P = 0.016). MAVD patients developing ≥ mild PVR after TAVR were also associated with higher mortality compared with the absence of PVR with an HR of 1.30 and 95% CI: 1.04-1.62 (P = 0.022). CONCLUSION: MAVD is prevalent among TAVR patients and presents unique challenges, with increased PVR risk and worse outcomes compared with isolated AS. Long-term survival for MAVD patients, not limited to those developing PVR post-TAVR, is compromised. Earlier intervention before the occurrence of structural myocardial damage or surgical valve replacement might be a potential workaround to improve outcomes.
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Demirel et al. (2024) conducted a cohort in Mixed aortic valve disease and severe aortic stenosis (n=880). Mixed aortic valve disease (MAVD) vs. Isolated aortic stenosis (AS) was evaluated on Paravalvular regurgitation (PVR) (OR 2.06, 95% CI 1.51-2.81, p=<0.001). Mixed aortic valve disease in TAVR patients was associated with a higher risk of paravalvular regurgitation compared with isolated aortic stenosis (OR 2.06; 95% CI 1.51-2.81; P<0.001).
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