Background: The association of severe aortic stenosis and mitral regurgitation (MR) is not rare in patients undergoing transcatheteraortic valve implantation (TAVI). The effect of TAVI on MR and its impact on outcome was evaluated.
Methods: All patients undergoing TAVI in our center were evaluated. Patients with paravalvular leak or residual aortic stenosis were excluded. Ninety-seven out of 166 patients undergoing successful TAVI had echocardiographic data on MR prior to the procedure. Forty-eight patients had follow-up data on post-procedural MR and constituted the patient population. Mitral regurgitation severity was divided into two categories for survival analysis, minimal (none/mild MR [grade 0-1/4]) and significant MR (moderate/severe MR [grade 2-4/4]). Patients were followed for a median of 420 days for death and development of heart failure (HF).
Results: Average age was 82±7, 48% were male; Euroscore was 21±17. MR pre-procedural was absent, mild, moderate and severe in 4 (8.3%), 25 (52%), 10 (21%) and 9 (19%) patients respectively. Mitral regurgitation remained unchanged in 27 (56%), improved in 13 (27%) and worsened in 8 (17%) patients. We divided patients into 4 groups based on pre and post MR. 25 patients (52%) had minimal MR and it remained minimal post-procedural, 4 (8.3%) had minimal MR but developed significant post-procedural MR; 5 (10%) had significant MR which became minimal after the procedure and 14 (29%) stayed with significant MR after the procedure. All patients that had significant MR post procedure developed HF while the lowest occurrence of HF was in patients that MR improved (P=0.004, Figure 1). A very similar result was seen when analyzing the combined end-point of death and HF (P=0.003).
Conclusion: Changes in the severity of MR after successful TAVI has a significant impact on the probability of developing HF.
Figure 1. Kaplan-Meier survival curves based on changes in MR. 
