Department of Medicine, Unit of Cardiology, Karolinska Institutet, Stockholm, Sweden; Heart and Vascular Theme, Department of Cardiology, Karolinska University Hospital, 171 76 Stockholm, Sweden. Electronic address: kari.feldt@ki.se.
The impact of a change in mitral regurgitation (MR) following TAVR is unknown. We studied the impact of baseline MR and early post-procedural change in MR on survival following TAVR.
The SWEDEHEART registry included all TAVRs performed in Sweden. Patients were dichotomized into no/mild and moderate/severe MR groups. Vital status, echocardiographic data at baseline and within 7?days after TAVR were analyzed.
1712 patients were included. 1404 (82%) had no/mild MR and 308 (18%) had moderate/severe MR. Baseline moderate/severe MR conferred a higher mortality rate at 5-year follow-up (adjusted HR 1.29, CI 1.01-1.65, p?=?0.04). Using persistent =mild MR as the reference, when moderate/severe MR persisted or if MR worsened from =mild at baseline to moderate/severe after TAVR, higher 5-year mortality rates were seen (adjusted HR 1.66, CI 1.17-2.34, p?=?0.04; adjusted HR 1.97, CI 1.29-3.00, p?=?0.002, respectively). If baseline moderate/severe MR improved to =mild after TAVR no excess mortality was seen (HR 1.09, CI 0.75-1.58, p?=?0.67). Paravalvular aortic regurgitation (PVL) was inversely associated with MR improvement after TAVR (OR 0.4, 95%: CI 0.17-0.94; p?=?0.034). Atrial fibrillation (OR 2.1, 95% CI: 1.27-3.39, p?=?0.004), self-expanding valve (OR 3.8, 95% CI: 2.08-7.14, p?