Evaluating the effect of multivalvular disease on mortality after transcatheter aortic valve replacement for aortic stenosis: a meta-analysis and systematic review

Aims: To determine the prognosis of multivalvular disease in patients undergoing transcatheter aortic valve replacement (TAVR) for severe aortic stenosis. Methods: Patients undergoing TAVR for aortic stenosis with covariate-adjusted risk of mortality associated with concomitant valve disease (mitral regurgitation [MR], mitral stenosis [MS] or tricuspid regurgitation [TR]) were included. Results: Moderate-to-severe MR was associated with increased mortality at 30 days (hazard ratio [HR]: 1.60; 95% CI: 1.11-2.30; p = 0.01) and 1 year (HR: 1.87; 95% CI: 1.22-2.87; p = 0.004). The presence of all-grade MS did not impact 30-day or 1-year mortality (HR, 30 days: 1.60; 95% CI: 0.71-3.63; p = 0.26; and HR, 1 year: 1.90; 95% CI: 0.98-3.69; p = 0.06); however, an increased risk of 1-year mortality (HR: 1.67; 95% CI: 1.03-2.70; p = 0.04) was observed with severe MS compared with no MS. Moderate-to-severe TR had a higher risk of all-cause mortality at 1 year (HR: 1.49; 95% CI: 1.24-1.78; p < 0.001) compared with no or mild TR. Conclusion: Moderate-to-severe MR or TR, and severe MS, significantly increase mid-term mortality after TAVR. Plain language summary: Transcatheter aortic valve replacement (TAVR) is a minimally invasive heart procedure to replace a thickened aortic valve (aortic stenosis). In the current era, the use of TAVR has increased in patients suffering from uncomfortable and potentially life-threatening symptoms of severe aortic stenosis who are at increased risk for undergoing a surgical procedure to replace their valves. However, accompanying valve diseases like mitral regurgitation (mitral valve cannot close tightly), mitral stenosis (a narrowed mitral valve) and tricuspid regurgitation (tricuspid valve cannot close tightly) are highly common in these patients. Therefore in this paper we assessed the effect of accompanying valvular disorders on the likelihood of death following TAVR in this patient population. Our findings suggest that accompanying moderate-to-severe mitral regurgitation and tricuspid regurgitation leads to an increase in deaths post-TAVR. Likewise, severe mitral stenosis also increased the risk of deaths after TAVR.