Mitral Regurgitation after TAVR

Figures

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  Figure 1. Severity of Mitral Regurgitation Over Time Bar chart displaying changes in the severity of mitral regurgitation (MR) over time. The majority of patients who survived to 3 years had mild or less MR while over half did not survive (purple). Death reflects patient vital status at the time of follow-up and is not a category of MR severity.

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  Figure 2. Discriminative Performance of Patients Achieving Mild or Less Mitral Regurgitation C-statistic curve demonstrating discriminative performance of the multivariable logistic regression model for patients who achieved MR improvement to mild or less. The C-statistic was 0.81 (95% CI: 0.78-0.87, bootstrap 1,000 resamples), reflecting good model discrimination. The curve was constructed using predicted probabilities from the full multivariable model presented in Table 2. This model has not been externally validated and should be considered exploratory. ROC = receiver operating characteristic.

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  Figure 3. Survival by Residual Mitral Regurgitation Grade Kaplan-Meier survival curves with pairwise comparisons for residual mitral regurgitation grade for all patients (classic and low-flow low-gradient aortic stenosis combined). Residual severe and moderate MR was associated with increased mortality vs no MR. MR = mitral regurgitation; TAVR = transcatheter aortic valve replacement.

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  Figure 4. Survival by Residual Mitral Regurgitation Grade in Low-Flow Low-Gradient Aortic Stenosis Kaplan-Meier survival curves with pairwise comparisons for residual mitral regurgitation grade for patients with low-flow low-gradient aortic stenosis. Residual severe MR was associated with increased mortality vs moderate, mild, and no MR. Abbreviations as in Figure 3.

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  Figure 5. Survival by Residual Mitral Regurgitation Grade in Classic Aortic Stenosis Kaplan-Meier survival curves with pairwise comparisons for residual mitral regurgitation (MR) grade for patients with classic aortic stenosis. There is a trend toward worsening survival with severe MR; however, this was not statistically significant. Abbreviation as in Figure 3.

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  Central Illustration. TAVR Patients with Moderate or Severe Mitral Regurgitation (MR): Sex Differences, As Subtype, NR Improvement, and Survival Among 344 patients with severe aortic stenosis and moderate or severe mitral regurgitation (MR) undergoing transcatheter aortic valve replacement (TAVR), MR improved by at least 1 grade in 62.8% and to mild or less in 52.9% of patients. Severe baseline MR, female sex, and hypertension were associated with lower odds of MR improvement. In patients with low-flow low-gradient (LFLG) aortic stenosis, higher pre-TAVR mean gradient predicted MR improvement. Residual severe MR was associated with increased mortality, primarily among patients with LFLG aortic stenosis. AS = aortic stenosis; AVA = aortic valve area; LFLG = low-flow low-gradient; MR = mitral regurgitation; TAVR = transcatheter aortic valve replacement.