Key result
TAVR for native AR downstages secondary MR in ~50% of patients, avoiding staged mitral intervention.
Why the study?
Evidence on a sequential downstream transcatheter approach for treating native severe aortic and mitral regurgitation is limited.
Does isolated transcatheter aortic valve replacement for native severe aortic regurgitation reduce the severity of concomitant severe mitral regurgitation and prevent the need for further mitral intervention in high surgical risk patients?
Case Report (n=4)
Does isolated transcatheter aortic valve replacement for native severe aortic regurgitation reduce the severity of concomitant severe mitral regurgitation and prevent the need for further mitral intervention in high surgical risk patients?
In patients with combined severe aortic and mitral regurgitation, isolated TAVR may lead to regression of secondary MR, supporting a staged reassessment strategy to avoid unnecessary mitral interventions.
AR correction may downstage secondary MR via reverse remodeling; leaves open whether sequential TAVR avoids mitral intervention in high-risk patients.
BACKGROUND: Concomitant severe aortic (AR) and mitral regurgitation (MR) affects up to 25% of patients with aortic valve disease and portends poor prognosis. Evidence on a sequential downstream approach in native AR is limited. CASE SUMMARY: We report 4 patients with high surgical risk (mean age 82 years, Society of Thoracic Surgeons score >8) with severe AR and MR treated with transcatheter aortic valve replacement for native AR. In 2 patients with secondary MR, AR correction was followed by reverse remodeling and downstaging of MR from severe to moderate, avoiding mitral transcatheter edge-to-edge repair. In the remaining 2 patients, MR remained severe, and staged mitral transcatheter edge-to-edge repair was performed. DISCUSSION: These cases support the hypothesis that MR etiology, rather than AR correction alone, determines whether MR regresses after isolated AR treatment. TAKE-HOME MESSAGE: MR etiology and post-transcatheter aortic valve replacement reassessment may guide a staged transcatheter strategy, sparing unnecessary mitral intervention in inoperable patients with combined AR/MR.
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Massussi et al. (2026) conducted a case report in Severe aortic and mitral regurgitation (n=4). Transcatheter aortic valve replacement was evaluated on Mitral regurgitation severity post-TAVR. Transcatheter aortic valve replacement for native AR led to MR downstaging to moderate in 2 of 4 patients with secondary MR, sparing them from additional mitral intervention.
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