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DOI: 10.1055/s-0036-1571742
The Change of Mitral Regurgitation Severity after Transfemoral versus transapical Transcatheter Aortic Valve Implantation (TAVI): Data from the VIenna CardioThOracic Aortic Valve RegistrY (VICTORY)
Objectives: The objective of this study is to find distinctive aspects of patients and access routes associated with MR improvement after TAVI.
Methods: MR changes were assessed in 228 patients before and after TAVI by comparing transthoracic echocardiography. Peak and mean pressure gradients across the aortic valve, the annulus diameter and the LVEF were measured as well as the color flow Doppler signal was used to determine the presence and grade of aortic regurgitation. MR was assessed by visual inspection and color-flow Doppler. The patients qualified as TAVI candidates as they had severe symptomatic aortic stenosis and were at high or prohibitive surgical risk. The transapical (TA) access route had been chosen in case of severe kinking or calcification of the iliac vessels.
Results: After the procedure, the number of patients suffering from MR was significantly reduced from 90.4% to 62.6% (p < 0.001) in the transfemoral (TF) TAVI population. For patients within the transapical (TA) cohort a significant drop from 87.6% to 53.4% (p < 0.001) had been observed. More than half of the patients (48.2%) with severe or moderate had improved in the TF-cohort versus 67.3% in the TA-cohort (p = 0.032). This improvement was not influenced by the prosthetic valve type (54.2% in Symetis, 49.3% in CoreValve, 43.9% in Edwards SAPIEN), the approach (51.2% in femoral, 41.7% in transapical), nor the operative or incremental risk (50% in log. EuroSCORE >20, 48.6% in log. EuroSCORE < 20). Patients with improved MR were less likely to have diabetes, a history of myocardial infarction, coronary artery disease and normal LVEF.
No significant differences were shown between both groups concerning the post-procedural complications defined according the VARC-2 Criteria and the 30-day mortality. Even though all patients showed significant improvement in NYHA class post implant, patients with moderate and severe MR featured less improvement (p = 0.036) and had a lower long-term survival (log rank p = 0.033).
Conclusion: A significant improvement of MR after TAVI could be shown in this study, especially among patients with severe MR. Preoperative moderate/severe MR as common comorbidity in patients referred for TAVI procedure is associated with a lower long-term survival rate and less improvement in NYHA class and therefore characterizes a high risk population. These findings however, have to be confirmed in a larger multicenter study.