Key result
Moderate-to-severe mitral regurgitation significantly increased 1-year mortality after TAVR (HR 1.87; 95% CI 1.22-2.87; p=0.004), alongside severe MS and moderate-to-severe TR.
Why the study?
The prognosis of multivalvular disease in patients undergoing TAVR for severe aortic stenosis required evaluation.
Does concomitant multivalvular disease increase mortality in patients undergoing TAVR for severe aortic stenosis?
Meta-Analysis
Does concomitant multivalvular disease increase mortality in patients undergoing TAVR for severe aortic stenosis?
Hazard Ratio: 1.87 (95% CI 1.22–2.87)
p-value: p=0.004
Concomitant moderate-to-severe mitral regurgitation, severe mitral stenosis, or moderate-to-severe tricuspid regurgitation significantly increases mid-term mortality in patients undergoing TAVR for severe aortic stenosis.
Supports multivalvular risk stratification before TAVR; extends single-center data to pooled meta-analytic confirmation.
Aims: To determine the prognosis of multivalvular disease in patients undergoing transcatheter aortic valve replacement (TAVR) for severe aortic stenosis. Methods: Patients undergoing TAVR for aortic stenosis with covariate-adjusted risk of mortality associated with concomitant valve disease (mitral regurgitation [MR], mitral stenosis [MS] or tricuspid regurgitation [TR]) were included. Results: Moderate-to-severe MR was associated with increased mortality at 30 days (hazard ratio [HR]: 1.60; 95% CI: 1.11–2.30; p = 0.01) and 1 year (HR: 1.87; 95% CI: 1.22–2.87; p = 0.004). The presence of all-grade MS did not impact 30-day or 1-year mortality (HR, 30 days: 1.60; 95% CI: 0.71–3.63; p = 0.26; and HR, 1 year: 1.90; 95% CI: 0.98–3.69; p = 0.06); however, an increased risk of 1-year mortality (HR: 1.67; 95% CI: 1.03–2.70; p = 0.04) was observed with severe MS compared with no MS. Moderate-to-severe TR had a higher risk of all-cause mortality at 1 year (HR: 1.49; 95% CI: 1.24–1.78; p < 0.001) compared with no or mild TR. Conclusion: Moderate-to-severe MR or TR, and severe MS, significantly increase mid-term mortality after TAVR.
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Siddiqi et al. (2022) conducted a meta-analysis in Severe aortic stenosis. Concomitant multivalvular disease (MR, MS, or TR) vs. No or mild concomitant valve disease was evaluated on 1-year mortality (moderate-to-severe MR vs no/mild MR) (HR 1.87, 95% CI 1.22-2.87, p=0.004). Moderate-to-severe mitral regurgitation significantly increased 1-year mortality after TAVR (HR 1.87; 95% CI 1.22-2.87; p=0.004), alongside severe MS and moderate-to-severe TR.
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