Relationship between Mitral Regurgitation and Transcatheter Aortic Valve Implantation: a Multi-Institutional Follow-up Study

被引:1
作者
da Cunha, Luciana de Cerjat Bernardes P. [1 ]
Guerios, Enio Eduardo [1 ]
Pereira da Cunha, Claudio Leinig [1 ]
Carvalho, Luiz A. [2 ]
Lemos Neto, Pedro [3 ]
Sarmento-Leite, Rogerio [4 ]
Abizaid, Alexandre A. [3 ]
Mangione, Jose Antonio [5 ]
Oliveira, Adriano Dourado [6 ]
Siciliano, Alexandre [3 ]
Esteves, Vinicius [7 ]
de Brito Jr, Fabio Sandoli [8 ,9 ]
机构
[1] Univ Fed Parana, Hosp Clin UFPR, Curitiba, Parana, Brazil
[2] Hosp ProCardiaco, Rio De Janeiro, RJ, Brazil
[3] Hosp Israelita Albert Einstein, Sao Paulo, SP, Brazil
[4] Inst Cardiol, Porto Alegre, RS, Brazil
[5] Hosp Beneficencia Portuguesa Sao Paulo, Sao Paulo, SP, Brazil
[6] Hosp Santa Izabel, Salvador, BA, Brazil
[7] Rede DOr Sao Luiz, Sao Paulo, SP, Brazil
[8] Univ Sao Paulo, Inst Coracao, Sao Paulo, SP, Brazil
[9] Hosp Sirio Libanes, Sao Paulo, SP, Brazil
关键词
Aortic Valve Insuffciency; Mitral Valve Insufficiency; Aortic Valve Transcatheter Implantation; Epidemiology; Survival Analysis; Echocardiography/methods; IMPACT; REPLACEMENT; OUTCOMES; STENOSIS; MORTALITY; RISK; TAVI; METAANALYSIS; SURVIVAL; MODERATE;
D O I
10.36660/abc.20190772
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background: Mitral regurgitation (MR) is prevalent in patients undergoing transcatheter aortic valve implantation (TAVI). There are some controversies about the prognostic impact of MR in survival of TAVI patients. Objective: To examine the relationship between TAVI and MR in a patient population from the Brazilian TAVI Registry. Methods: Seven hundred and ninety-five patients from the Brazilian TAVI Registry were divided at baseline, discharge, and follow-up according to their MR grade as follows: absent/mild (AMMR) or moderate/severe (MSMR). They were subsequently regrouped according to their immediate and late changes in MR severity after TAVI as follows: no change, improved, or worsened MR. Predictors and prognostic impact on baseline as well as changes in MR severity were analyzed. Statistical significance was set at p < 0.05. Results: Baseline MSMR was present in 19.3% of patients and was a predictor of increased late mortality. Immediately after TAVI, 47.4 % of cases improved to AMMR, predicted by a higher Society of Thoracic Surgeons score and a higher grade of baseline aortic regurgitation. Upon follow-up, 9.2% of cases of AMMR worsened to MSMR, whereas 36.8% of cases of MSMR improved to AMMR. Lower baseline left ventricular ejection fraction (LVEF) and improvement in LVEF at follow-up were predictors of MR improvement. Progressive worsening of MR upon follow-up was an independent predictor of higher late mortality after TAVI (p = 0.005). Conclusions: Baseline MSMR predicts late mortality after TAVI. Lower LVEF and improved LVEF at follow-up predict MR improvement after TAVI. Progressive worsening of MR severity at follow-up is an independent predictor of late mortality, which is a rare finding in the literature.
引用
收藏
页码:1059 / 1068
页数:10
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