Author + information
- Received April 1, 2019
- Revision received May 28, 2019
- Accepted June 6, 2019
- Published online October 30, 2019.
- Johnny Chahine, MDa,
- Amer N. Kadri, MDa,
- Rama D. Gajulapalli, MDa,
- Amar Krishnaswamy, MDb,
- Stephanie Mick, MDc,
- Oscar Perez, MDa,
- Hassan Lak, MDa,
- Raunak M. Nair, MDa,
- Bryce Montane, MDa,
- James Tak, MDa,
- E. Murat Tuzcu, MDb,
- Brian Griffin, MDb,
- Lars G. Svensson, MD, PhDc,
- Serge C. Harb, MDb and
- Samir R. Kapadia, MDb,∗ ()
- aDepartment of Medicine, Cleveland Clinic, Cleveland, Ohio
- bDepartment of Cardiovascular Medicine, Aortic Valve Center, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
- cDepartment of Thoracic and Cardiovascular Surgery, Aortic Valve Center, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
- ↵∗Address for correspondence:
Dr. Samir Kapadia, Department of Cardiovascular Medicine, Aortic Valve Center, Cleveland Clinic, Mail Code J2-3, 9500 Euclid Avenue, Cleveland, Ohio 44195.
Objectives The aim of this study was to compare outcomes after transcatheter aortic valve replacement (TAVR) in patients with pure aortic stenosis (AS) (i.e., no or trivial associated aortic regurgitation [AR]) with those in patients with AS and mild or more severe AR (i.e., mixed aortic valve disease [MAVD]).
Background TAVR is indicated in treating patients with severe AS. Limited data exist regarding the outcomes of TAVR in patients with MAVD.
Methods A total of 1,133 patients who underwent TAVR between January 2014 and December 2017 were included. The primary outcome was all-cause mortality. The comparison was adjusted to account for post-TAVR AR development in both groups. The secondary outcomes included composite endpoints of early safety and clinical efficacy as specified in the Valve Academic Research Consortium-2 criteria. Variables were compared using Mann-Whitney, chi-square, and Fisher exact tests, while Kaplan-Meier analyses were used to compare survival.
Results A total of 688 patients (61%) had MAVD (median age 83, 43% women). Among these, 17% developed mild, 2% moderate, and <1% severe post-TAVR AR. Overall, patients with MAVD had better survival compared with patients with pure AS (p = 0.03). Among patients who developed post-TAVR AR, those in the MAVD group had better survival (p = 0.04). In contrast, in patients who did not develop post-TAVR AR, pre-TAVR AR did not improve survival (p = 0.11).
Conclusions Patients with MAVD who underwent TAVR had better survival compared with patients with pure AS. This is explained by the better survival of patients with MAVD who developed post-TAVR AR, likely due to left ventricular adaptation to AR.
- aortic regurgitation
- aortic stenosis
- mixed aortic valve disease
- paravalvular regurgitation
- transcatheter aortic valve replacement
The authors have reported that they have no relationships relevant to the contents of this paper to disclose. Bernard Prendergast, DM, served as the Guest Editor for this paper.
- Received April 1, 2019.
- Revision received May 28, 2019.
- Accepted June 6, 2019.
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