Development of atrioventricular valve regurgitation following transcatheter aortic valve replacement for severe aortic stenosis

BACKGROUND: Concomitant mitral (MR) and/or tricuspid regurgitation (TR) in patients with aortic stenosis (AS) is often regarded as a late-stage disease manifestation, resulting from left ventricular damage, pulmonary hypertension, and right heart dysfunction. However, we assume that atrioventricular valve regurgitation in the context of severe AS may often develop as an independent entity, but knowledge regarding these patients and their risk factors is scarce. OBJECTIVES: The aim of this study was to characterize patients who develop atrioventricular valve regurgitation after transcatheter aortic valve replacement (TAVR) and its impact on mortality. METHODS: We analyzed patients with severe AS but without concomitant atrioventricular valve disease undergoing TAVR between January 2016 and December 2021. Novel MR and/or TR ≥ grade 2 and its impact on 3-year all-cause and cardiovascular mortality were evaluated. RESULTS: A total of 1034 TAVR patients without preexisting atrioventricular valve regurgitation were included in the study. Of these, 114 patients (11.0%) developed relevant mitral and/or tricuspid regurgitation. Among them, 17 patients experienced combined MR and TR, 75 patients had isolated MR, and 22 patients had isolated TR. The development of atrioventricular valve regurgitation after TAVR was associated with significantly increased 3-year all-cause (p < 0.01) and cardiovascular mortality (p < 0.001). CONCLUSIONS: In patients with severe AS but without concomitant atrioventricular valve disease at baseline, a relevant proportion of patients developed MR and/or TR after TAVR despite the relief of outflow obstruction. Moreover, patients with new-onset atrioventricular valve regurgitation had a significantly higher 3-year all-cause and cardiovascular mortality.