Key result
Post-operative mitral regurgitation (OR 10.05; 95% CI 2.08-48.57) and coronary artery disease independently predicted the non-occurrence of left ventricular reverse remodeling after TAVR.
Why the study?
Previous studies regarding mixed aortic valve disease are contradictory, necessitating a new perspective to assess the value of TAVR in this population compared to predominant aortic stenosis.
Does TAVR lead to left ventricular reverse remodeling in patients with mixed aortic valve disease compared to predominant aortic stenosis?
Cohort (n=162)
No
Does TAVR lead to left ventricular reverse remodeling in patients with mixed aortic valve disease compared to predominant aortic stenosis?
Effect estimate: OR 10.05 (95% CI 2.08-48.57)
p-value: p=< .001
TAVR induces left ventricular reverse remodeling in patients with mixed aortic valve disease, though post-operative mitral regurgitation and coronary artery disease increase the risk of non-remodeling.
Post-operative MR and CAD may flag TAVR patients unlikely to remodel; leaves open effects in mixed aortic valve disease.
BACKGROUND: Mixed aortic valve disease (MAVD) is a frequent concomitant valve disease with unique cardiac pathological changes compared to predominant aortic stenosis (PAS). The previous studies about the MAVD are contradictory. Therefore, a new perspective is needed to assess the value of TAVR for this cohort of patients. METHODS: From January 2018 to December 2021, 90 MAVD patients and 72 PAS patients who underwent TAVR in our hospital were collected. 1:1 propensity score matching analysis was used to control the bias in patient selection. The dynamic changes in left ventricular morphology and hemodynamics were compared by generalized estimating equations. Univariate or multivariate logistic regression analysis was used to screen for independent risk factors for the non-occurrence of left ventricular reverse remodeling (non-LVRR). RESULTS: After the matching procedure, 112 patients were included in the analysis (56 in each group). Baseline characteristics were similar between the two groups. LVRR occurred in both groups, but MAVD had greater left ventricular end-diastolic volume index and left ventricular mass index, a higher incidence of mitral regurgitation (MR), and a more pronounced transformation of ventricular geometry patterns. Post-operative MR (odd ratio [OR]: 10.05; 95% confidence interval [CI]: 2.08-48.57; p < .001) and coronary artery disease (OR: 2.82; 95% CI: 1.08-7.34; p = .034) were independent risk factors for non-LVRR. CONCLUSION: LVRR also occurs in patients with MAVD, post-operative MR and coronary artery disease were independent risk factors for non-LVRR.
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Huang et al. (2023) conducted a cohort in Mixed aortic valve disease and predominant aortic stenosis (n=162). Transcatheter aortic valve replacement (TAVR) vs. Predominant aortic stenosis (PAS) was evaluated on Non-occurrence of left ventricular reverse remodeling (non-LVRR) (OR 10.05, 95% CI 2.08-48.57, p=< .001). Post-operative mitral regurgitation (OR 10.05; 95% CI 2.08-48.57) and coronary artery disease independently predicted the non-occurrence of left ventricular reverse remodeling after TAVR.
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