Aims: The aim of this study was to evaluate the clinical impact of post-operative mitral regurgitation (MR) after transcatheter aortic valve replacement (TAVR).
Methods: Prospectively collected clinical and echo Doppler data of 444 consecutive patients who underwent TARV was retrospectively evaluated. Primary end point was two-year total mortality; secondary combined end point was the-year mortality, readmission for heart failure and new onset atrial fibrillation. Post TARV mitral regurgitation and AV prosthesis paravalvular leak was graded according to established criteria from 0 to 3.
Results: The TAVR cohort mean age was 82±6 years; 58 % were female; mean left ventricular ejection fraction 56±6 5; trans-aortic peak pressure 76.6±24mmHg; aortic valve area 0.72±0.2; pulmonary systolic arterial pressure 41±12 mmHg. Post procedural mitral MR grade predicted higher mortality (Hazard ratio [HR] 1.4[1.14-1.8]; p=0.002) and combined cardiac endpoint (death, readmission for heart failure and new onset atrial fibrillation rate), HR (1.6[1.3-1.9]; P<0.0001). Adjusted for background independent determinants of survival, older age (p=0.002), Euro-score (p<0.0001) and post procedural aortic paravalvular regurgitation (p=0.0002), post procedural MR grade independently predicted higher mortality (adjusted risk ratio 1.29[1.10-1.64], p=0.04), and higher event rate (4.4[2.0-9.1]; p=0.003). Two-year survival was higher with increasing MR grade (88±3 vs. 78±3 vs. 65±8 vs. 57±11 percent; p=0.01 for grade 0,1,2 and 3 MR respectively; figure). Two-year cardiac event free survival was lower with increasing MR grade (71±4 vs. 61±4 vs. 37±8 vs. 28±10 percent;
