Improvements In Mitral Regurgitation After Transcatheter Aortic Valve Replacement And The Impact On Prognosis

Background and objectives:Transcatheter aortic valve replacement(TAVR)is the first-line treatment for valvular heart disease(VHD)and is increasingly being employed in patients with full-risk spectrum aortic valve stenosis(AS).Of elderly patients with heart valve disease,it is estimated that approximately 29.5%suffer from combined valve disease,with mitral valve regurgitation(MR)being the most common complication of aortic valve stenosis.In patients subjected to TAVR,mitral regurgitation of various intensity often improves,but there are still circumstances in which mitral regurgitation remains unaltered or even worsens.In this regard,this study aims to investigate the improvement of mitral regurgitation in patients with severe aortic stenosis combined with different grades of mitral regurgitation after TAVR,analyze the independent risk factors for the improvement and worsening of mitral regurgitation after TAVR,and assess the impact of mitral regurgitation severity on the long-term prognosis of patients after TAVR.Methods:Patients with severe aortic stenosis combined with mitral regurgitation who had undergone TAVR by installing a self-expanding prosthetic aortic valve in Zhengzhou Seventh People’s Hospital and Henan Chest Hospital from April 2018 to July 2021 were retrospectively selected for this study.Adhering to the inclusion and exclusion criteria,150 patients were finally included,with their respective clinical information collected preceding and after the procedure and classified into MR<moderate and MR≥moderate groups depending on the degree of MR at one-month post-operation.Multifactorial logistic regression analysis was conducted to screen the independent risk factors liable for post-operative MR improvement,with the predictive value of the regression equation analysed with a ROC curve.Furthermore,independent risk factors for the occurrence of primary endpoint events at one-year post-operation were analysed by multifactorial Cox regression,and the predictive value of post-operative MR for primary endpoint events at one year was evaluated by ROC curves and Kaplan-Meier curves.Results:(1)Patients with mitral regurgitation(MR)who underwent transcatheter aortic valve replacement(TAVR)showed a significant improvement in MR compared to their previous condition,with 69.0%of patients in the moderate or higher MR group showing at least one grade of improvement;(2)Compared with the postoperative MR<moderate group,the postoperative MR ≥moderate group following TAVR was associated with worse structural and functional cardiac function,such as left ventricular end-diastolic diameter(LVEDD),left ventricular end-systolic diameter(LVESD),interventricular septum thickness(IVS),left ventricular ejection fraction(LVEF)and left atrial diameter(LAD);(3)LVEF,BMI and preoperative MR classification were associated with lower MR improvement after TAVR.(4)LVEF,IVS,MR grades and LAD after TAVR were identified as independent risk factors for the occurrence of primary endpoint events within one year,and postoperative MR grades were found to have a positive predictive value.(5)Patients in the moderate or higher MR group had a significantly lower mean survival time and a worse prognosis than those in the MR<moderate group at one year after TAVR.Conclusion:TAVR significantly improved functional mitral regurgitation in combination with severe aortic stenosis,and postoperative MR grade is an independent risk factor for major endpoint events at 1 year,and patients with moderate to severe MR have a worse prognosis.