Key result
Improved MR after AVR is linked to ~45% lower all-cause mortality versus persistent MR.
Why the study?
The study aimed to compare survival outcomes between patients with versus without improvement in untreated significant mitral regurgitation following SAVR or TAVR for severe aortic stenosis.
Does improvement in untreated significant mitral regurgitation after aortic valve replacement reduce all-cause mortality in patients with severe aortic stenosis?
Meta-Analysis (n=4,040)
Does improvement in untreated significant mitral regurgitation after aortic valve replacement reduce all-cause mortality in patients with severe aortic stenosis?
Improvement in significant mitral regurgitation following aortic valve replacement is associated with significantly lower all-cause mortality, highlighting the prognostic importance of MR regression.
Answers are grounded in this paper and cite their sources.
Improved post-AVR MR identifies lower-risk patients; extends meta-analytic confirmation of MR regression as a prognostic marker.
Background This meta-analysis aimed to compare survival outcomes among patients experiencing improvement in untreated significant mitral regurgitation (MR) following surgical aortic valve replacement (SAVR) or transcatheter aortic valve replacement (TAVR) for severe aortic stenosis, in contrast to those without improvement. Methods We conducted a comprehensive search through February 2024. Pooled hazard ratios (HR) with 95% confidence intervals (CI) were computed. Kaplan-Meier curves depicting all-cause mortality were reconstructed using individual patient data derived from the included studies. Results A systematic review identified twelve non-randomized studies encompassing 4040 patients. The pooled all-cause mortality of the meta-analysis demonstrated a significant reduction in patients whose MR improved compared to those with persistent MR after aortic valve replacement (AVR) (HR [95% CI] = 0.55 [0.47–0.64], p < .01). The hazard ratio, derived from reconstructed time-to-event data, indicated lower all-cause mortality in patients with improved MR after AVR relative to the other cohort (HR [95% CI] = 0.50 [0.40–0.62], p < .01 in all patients, 0.48 [0.34–0.68], p < .01 in patients undergoing SAVR, and 0.58 [0.42–0.80], p < .01 in those receiving TAVR). Conclusion In conclusion, this meta-analysis revealed that improved MR after AVR, whether surgically or by transcatheter approach, correlates with superior survival. The benefits of simultaneous or staged intervention on the mitral valve in individuals undergoing AVR warrant validation in future investigations.
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Naito et al. (2024) conducted a meta-analysis in Severe aortic stenosis with untreated significant mitral regurgitation (n=4,040). Improvement in mitral regurgitation vs. Persistent mitral regurgitation (no improvement) was evaluated on All-cause mortality (HR 0.55, 95% CI 0.47-0.64, p=<.01). Improved mitral regurgitation following aortic valve replacement was associated with significantly lower all-cause mortality compared to persistent MR (HR 0.55; 95% CI 0.47-0.64; p<0.01).
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