Arq. Bras. Cardiol. 2021; 116(6): 1070-1071
Mitral Regurgitation and Transcatheter Aortic Valve Replacement: Are There Any Other Prognostic Implications?
This Short Editorial is referred by the Research article "Relationship between Mitral Regurgitation and Transcatheter Aortic Valve Implantation: a Multi-Institutional Follow-up Study".
There is a variable prevalence of moderate to severe mitral regurgitation (13 to 74%) in patients with severe degenerative aortic stenosis. – In elderly and frail patients, this association can generate clinical dilemmas in cardiological practice: should I submit my patient to combined valve surgery, exposing him to higher morbidity and mortality, or contemplate only the severe aortic stenosis with a less aggressive treatment represented by the transcatheter aortic valve replacement (TAVR)? The variable degrees of severity associated with the commonly functional etiology (up to 80%) of the associated mitral regurgitation, places aortic valve stenosis in a high prominent position at this clinical hierarchy, with a resultant predilection for performing TAVR in these scenarios. In fact, some studies showed an improvement in the mitral regurgitation severity after TAVR, especially in patients with functional etiology and without pulmonary hypertension or atrial fibrillation. –
The impact of baseline mitral regurgitation on patients undergoing TAVR is still controversial. Toggweiler et al. found that moderate to severe baseline mitral regurgitation in patients undergoing TAVR was associated with higher early mortality rates (first 30 days), with no difference in late mortality. Conversely, Barbanti et al., using data from the randomized Placement of Aortic Transcatheter Valve (PARTNER) trial cohort A, found that moderate to severe baseline mitral regurgitation was associated with higher late mortality only in the surgical aortic valve replacement group, with no prognostic implication in the TAVR group.
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