The Fate of Mitral Valve Regurgitation After TAVI

Background: Outcomes of patients undergoing transcatheter aortic valve implantation (TAVI) for severe aortic stenosis with concomitant severe mitral regurgitation (MR) remain incompletely defined. This study aimed to quantify the evolution of high-grade MR after TAVI, compare changes using MR etiology, and assess associations between MR etiology, early improvement, or residual discharge MR and mortality. Methods: In a retrospective single-center cohort, 112 TAVI patients with baseline more-than-moderate MR were included (functional n = 94; degenerative n = 18). MR grade was assessed pre-TAVI, at discharge, and at last available follow-up (serial studies up to ≥5 years), and 5-year all-cause mortality was analyzed. Results: At discharge, 34% of patients improved by more than one MR grade, and 26% by one grade. Among 45 patients with available late echocardiographic follow-up, 62% improved by more than one grade, 24% by one grade. Exploratory five-year survival analyses did not demonstrate a significant difference for MR etiology (p = 0.23), discharge MR grade (p = 0.11), or MR improvement status (p = 0.12). Conclusions: Among patients surviving to longitudinal echocardiographic follow-up, MR reduction was frequently observed after TAVI. Exploratory analyses did not demonstrate statistically significant differences in 5-year survival according to MR etiology, early MR improvement, or discharge MR severity. However, limited sample size and incomplete follow-up preclude definitive prognostic conclusions. Overall, these findings are compatible with a surveillance-first management, and with individualized consideration of adjunctive mitral therapy for persistent higher-grade symptomatic MR.