Persistent mitral regurgitation after TAVR more common among women than men
Persistent mitral regurgitation (MR) after transcatheter aortic valve replacement (TAVR) is more common in women and in patients who present with severe MR, according to new data published in JACC: Advances.[1] The study’s authors also found that MR following TAVR can be especially harmful for patients with low-flow low-gradient aortic stenosis (LFLG AS).
This single-center study included data from 344 consecutive TAVR patients who presented with severe aortic stenosis and moderate to severe MR at baseline. The average age was 81.9 years old, and 48.5% of patients were women. Common comorbidities included hypertension (91%), atrial fibrillation/flutter (58.4%), coronary artery disease (56.7%) and chronic lung disease (43.9%). Forty-five percent of patients presented with LFLG AS, which can be more challenging to diagnose.
Overall, MR improved after TAVR by at least one grade in 62.8% of patients. This included 63% of patients with traditional aortic stenosis and 62.6% of those with LFLG AS. MR improved to mild or better in 52.9% of patients.
Researchers found that patients with severe MR at baseline were associated with significantly lower odds of their MR improving to mild or less following TAVR. Women and patients with hypertension were also less common to have their MR improve to mild or less.
When looking at patients with LFLG AS, meanwhile, the mortality risk for patients with residual severe MR following TAVR was three times higher than it was for patients with no post-TAVR MR.
“Understanding that women are at higher risk of persistent MR should influence preprocedural counseling and could influence patient selection,” wrote first author Eric Warner, MD, a cardiac researcher with Cleveland Clinic, and colleagues. “It is important to acknowledge that persistent severe MR after TAVR may reflect more advanced underlying myocardial or atrial disease, rather than serve as an independent driver of mortality. Accordingly, the association between residual severe MR and worse survival in LFLG AS patients should be interpreted cautiously. Any decision regarding subsequent mitral valve intervention, whether transcatheter edge-to-edge repair or surgical correction, should be individualized based on MR mechanism, symptom burden, LV size and function, pulmonary pressures, mitral anatomy, frailty, and overall procedural candidacy.”
Click here for the full study in JACC: Advances, an American College of Cardiology journal.
Michael has more than 19 years of experience as a professional writer and editor. He has written at length about cardiology, radiology, artificial intelligence and other key healthcare topics.