PMID- 37042426 OWN - NLM STAT- MEDLINE DCOM- 20230823 LR - 20231023 IS - 1969-6213 (Electronic) IS - 1774-024X (Print) IS - 1774-024X (Linking) VI - 19 IP - 6 DP - 2023 Aug 21 TI - Impact of mitral regurgitation aetiology on the outcomes of transcatheter aortic valve implantation. PG - 526-536 LID - EIJ-D-22-01062 [pii] LID - 10.4244/EIJ-D-22-01062 [doi] AB - BACKGROUND: Concomitant moderate/severe mitral regurgitation (MR) is observed in 17-35% of patients undergoing transcatheter aortic valve implantation (TAVI) and contributes to a worse prognosis. Studies analysing outcomes in patients undergoing TAVI with different MR aetiologies, including atrial functional MR (aFMR), are lacking. AIMS: We aimed to analyse outcomes and changes in MR severity in patients with aFMR, ventricular functional (vFMR) and primary mitral regurgitation (PMR) following TAVI. METHODS: We analysed all consecutive patients with at least moderate MR undergoing TAVI between January 2013 and December 2020 at the Munich University Hospital. Characterisation of MR aetiology was performed by detailed individual echocardiographic assessment. Three-year mortality, changes in MR severity and New York Heart Association (NYHA) Functional Class at follow-up were assessed. RESULTS: Out of 3,474 patients undergoing TAVI, 631 patients showed MR >/=2+ (172 with aFMR, 296 with vFMR, 163 with PMR). Procedural characteristics and endpoints were comparable between groups. The rate of MR improvement was 80.2% in aFMR patients, which was significantly higher compared to both other groups (vFMR: 69.4%; p=0.03; PMR: 40.8%; p<0.001). The estimated 3-year survival rates did not differ between aetiologies (p=0.57). However, MR persistence at follow-up was associated with increased mortality (hazard ratio 1.49, 95% confidence interval: 1.04-2.11; p=0.027), mainly driven by the PMR subgroup of patients. NYHA Class improved significantly in all groups. In patients with baseline MR >/=3+, the PMR aetiology was associated with the lowest MR improvement, the lowest survival rates and least symptomatic improvement. CONCLUSIONS: TAVI reduces MR severity and symptoms in patients with aFMR, vFMR and less-pronounced PMR. The presence of aFMR was associated with the greatest MR severity improvement. FAU - Doldi, Philipp Maximilian AU - Doldi PM AD - Medizinische Klinik und Poliklinik I, Klinikum der Universitat Munchen, Munich, Germany. AD - Munich Heart Alliance, German Center for Cardiovascular Research (DZHK), Munich, Germany. FAU - Steffen, Julius AU - Steffen J AD - Medizinische Klinik und Poliklinik I, Klinikum der Universitat Munchen, Munich, Germany. AD - Munich Heart Alliance, German Center for Cardiovascular Research (DZHK), Munich, Germany. FAU - Stolz, Lukas AU - Stolz L AD - Medizinische Klinik und Poliklinik I, Klinikum der Universitat Munchen, Munich, Germany. FAU - Fischer, Julius AU - Fischer J AD - Medizinische Klinik und Poliklinik I, Klinikum der Universitat Munchen, Munich, Germany. FAU - Stocker, Thomas J AU - Stocker TJ AD - Medizinische Klinik und Poliklinik I, Klinikum der Universitat Munchen, Munich, Germany. AD - Munich Heart Alliance, German Center for Cardiovascular Research (DZHK), Munich, Germany. FAU - Orban, Martin AU - Orban M AD - Medizinische Klinik und Poliklinik I, Klinikum der Universitat Munchen, Munich, Germany. AD - Munich Heart Alliance, German Center for Cardiovascular Research (DZHK), Munich, Germany. FAU - Theiss, Hans AU - Theiss H AD - Medizinische Klinik und Poliklinik I, Klinikum der Universitat Munchen, Munich, Germany. FAU - Rizas, Konstantinos AU - Rizas K AD - Medizinische Klinik und Poliklinik I, Klinikum der Universitat Munchen, Munich, Germany. AD - Munich Heart Alliance, German Center for Cardiovascular Research (DZHK), Munich, Germany. FAU - Sadoni, Sebastian AU - Sadoni S AD - Herzchirurgische Klinik und Poliklinik, Klinikum der Universitat Munchen, Munich, Germany. FAU - Hagl, Christian AU - Hagl C AD - Herzchirurgische Klinik und Poliklinik, Klinikum der Universitat Munchen, Munich, Germany. FAU - Massberg, Steffen AU - Massberg S AD - Medizinische Klinik und Poliklinik I, Klinikum der Universitat Munchen, Munich, Germany. AD - Munich Heart Alliance, German Center for Cardiovascular Research (DZHK), Munich, Germany. FAU - Hausleiter, Jorg AU - Hausleiter J AD - Medizinische Klinik und Poliklinik I, Klinikum der Universitat Munchen, Munich, Germany. AD - Munich Heart Alliance, German Center for Cardiovascular Research (DZHK), Munich, Germany. FAU - Braun, Daniel AU - Braun D AD - Medizinische Klinik und Poliklinik I, Klinikum der Universitat Munchen, Munich, Germany. AD - Munich Heart Alliance, German Center for Cardiovascular Research (DZHK), Munich, Germany. FAU - Deseive, Simon AU - Deseive S AD - Medizinische Klinik und Poliklinik I, Klinikum der Universitat Munchen, Munich, Germany. AD - Munich Heart Alliance, German Center for Cardiovascular Research (DZHK), Munich, Germany. LA - eng PT - Journal Article PL - France TA - EuroIntervention JT - EuroIntervention : journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology JID - 101251040 SB - IM CIN - EuroIntervention. 2023 Aug 21;19(6):457-458. PMID: 37605809 MH - Humans MH - *Transcatheter Aortic Valve Replacement/adverse effects MH - *Mitral Valve Insufficiency/diagnostic imaging/surgery/etiology MH - Treatment Outcome MH - Prognosis MH - Echocardiography MH - *Aortic Valve Stenosis/diagnosis MH - Severity of Illness Index MH - Aortic Valve/diagnostic imaging/surgery PMC - PMC10440686 COIS- D. Braun reports speaker honoraria from Abbott Vascular and Edwards Lifesciences. J Hausleiter has received speaker honoraria from Abbott Vascular and Edwards Lifesciences. J. Steffen reports speaker honoraria from AstraZeneca. S. Deseive has received speaker honoraria from AstraZeneca. The other authors have no conflicts of interest to declare. EDAT- 2023/04/13 06:00 MHDA- 2023/08/23 06:42 PMCR- 2024/08/21 CRDT- 2023/04/12 06:33 PHST- 2024/08/21 00:00 [pmc-release] PHST- 2023/08/23 06:42 [medline] PHST- 2023/04/13 06:00 [pubmed] PHST- 2023/04/12 06:33 [entrez] AID - EIJ-D-22-01062 [pii] AID - 10.4244/EIJ-D-22-01062 [doi] PST - ppublish SO - EuroIntervention. 2023 Aug 21;19(6):526-536. doi: 10.4244/EIJ-D-22-01062.