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Clinical impact and evolution of mitral regurgitation following transcatheter aortic valve replacement: a meta-analysis
  1. Luis Nombela-Franco1,2,
  2. Hélène Eltchaninoff3,
  3. Ralf Zahn4,
  4. Luca Testa5,
  5. Martin B Leon6,
  6. Ramiro Trillo-Nouche7,
  7. Augusto D'Onofrio8,
  8. Craig R Smith6,
  9. John Webb9,
  10. Sabine Bleiziffer10,
  11. Benedetta De Chiara11,
  12. Martine Gilard12,
  13. Corrado Tamburino13,
  14. Francesco Bedogni5,
  15. Marco Barbanti13,
  16. Stefano Salizzoni14,
  17. Bruno García del Blanco15,
  18. Manel Sabaté16,
  19. Antonella Moreo11,
  20. Cristina Fernández2,
  21. Henrique Barbosa Ribeiro1,
  22. Ignacio Amat-Santos1,
  23. Marina Urena1,
  24. Ricardo Allende1,
  25. Eulogio García2,
  26. Carlos Macaya2,
  27. Eric Dumont1,
  28. Philippe Pibarot1,
  29. Josep Rodés-Cabau1
  1. 1Quebec Heart & Lung Institute, Quebec city, Quebec, Canada
  2. 2Cardiovascular Institute, Hospital Clínico San Carlos, Madrid, Spain
  3. 3Cardiology Department, Charles Nicolle Hospital, University of Rouen, Rouen, France
  4. 4Abteilung für Kardiologie, Herzzentrum Ludwigshafen, Ludwigshafen, Germany
  5. 5Cardiology Department, Instituto Clinico S. Ambrogio, Milan, Italy
  6. 6Columbia University Medical Center/New York-Presbyterian Hospital, New York, USA
  7. 7Hospital Universitario de Santiago Compostela, A Coruña, Spain
  8. 8Division of Cardiac Surgery, University of Padova, Padova, Italy
  9. 9St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
  10. 10German Heart Center, Munich, Germany
  11. 11Cardiology Department, Niguarda Ca’ Granda Hospital, Milan, Italy
  12. 12Department of Cardiology, La Cavale Blanche Hospital, Brest, France
  13. 13Ferrarotto Hospital, Catania, Italy
  14. 14Department of Surgical Sciences Torino, Città della Salute e della Scienza Hospital, Molinette, Torino, Italy
  15. 15Department of Cardiology, Vall d'Hebron University Hospital, Barcelona, Spain
  16. 16Cardiology Department, Hospital Clinic de Barcelona, IDIBAPS, Barcelona, Spain
  1. Correspondence to Dr Josep Rodés-Cabau, Quebec Heart & Lung Institute, 2725 cheminSte-Foy, Quebec City, Quebec, Canada G1V 4G5; josep.rodes{at}criucpq.ulaval.ca

Abstract

Objectives Mitral regurgitation (MR) is a common entity in patients with aortic stenosis undergoing transcatheter aortic valve replacement (TAVR), but its influence on outcomes remains controversial. The purpose of this meta-analysis was to assess the clinical impact of and changes in significant (moderate–severe) MR in patients undergoing TAVR, overall and according to valve design (self-expandable (SEV) vs balloon-expandable (BEV)).

Methods All national registries and randomised trials were pooled using meta-analytical guidelines to establish the impact of moderate–severe MR on mortality after TAVR. Studies reporting changes in MR after TAVR on an individual level were electronically searched and used for the analysis.

Results Eight studies including 8015 patients (SEV: 3474 patients; BEV: 4492 patients) were included in the analysis. The overall 30-day and 1-year mortality was increased in patients with significant MR (OR 1.49, 95% CI 1.16 to 1.92; HR 1.32, 95% CI 1.12 to 1.55, respectively), but a significant heterogeneity across studies was observed (p<0.05). The impact of MR on mortality was not different between SEV and BEV in meta-regression analysis for 30-day (p=0.360) and 1-year (p=0.388) mortality. Changes in MR over time were evaluated in nine studies including 1278 patients. Moderate–severe MR (SEV: 326 patients; BEV: 192 patients) improved in 50.5% of the patients at a median follow-up of 180 (30–360) days after TAVR, and the degree of improvement was greater in patients who had received a BEV (66.7% vs 40.8% in the SEV group, p=0.001).

Conclusions Concomitant moderate–severe MR was associated with increased early and late mortality following TAVR. A significant improvement in MR severity was detected in half of the patients following TAVR, and the degree of improvement was greater in those patients who had received a BEV.

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