ISSN 2996-8215
International Journal of Cardiology | Vol. 15, No. 2, February 2024 | pp. 9–16
DOI: 10.46882/2024/IJC/000178
Original Research Article
Concomitant Secondary Mitral Regurgitation Behavior and Predictors of Spontaneous Resolution Post-TAVI
Matteo Barbieri¹, Francesca Costa¹, Luigi Marini²
¹Department of Cardiology, San Raffaele Hospital, Milan, Italy
²Division of Cardiac Surgery, University Hospital of Bologna, Bologna, Italy
Abstract:
Concomitant secondary mitral regurgitation (SMR) is common in elderly patients with severe aortic stenosis undergoing transcatheter aortic valve implantation (TAVI). Whether baseline moderate-to-severe SMR independently impairs long-term survival or predictably resolves post-TAVI remains an area of active investigation. This study investigated the 2-year clinical outcomes and post-procedural course of SMR in high-risk patients. We prospectively followed 180 consecutive high-risk patients with severe aortic stenosis who underwent successful TAVI. Patients were divided into two baseline cohorts: non-significant SMR (none, trace, or mild, n = 124) and significant SMR (moderate-to-severe, n = 56). The primary endpoint was a composite of all-cause mortality or heart failure hospitalization at 24 months. Significant SMR was associated with a higher baseline logistic EuroSCORE (24.2% ± 5.1%). At 2 years, the primary composite endpoint occurred significantly more frequently in patients with baseline significant SMR than in those with non-significant SMR (42.9% vs. 21.8%, log-rank p = 0.004). This difference was driven by higher rates of heart failure rehospitalization (32.1% vs. 13.7%, p = 0.01). Echocardiographic follow-up at 6 months revealed that SMR improved by at least one grade in 53.6% of patients, primarily in those with preserved baseline left ventricular function. Multivariable Cox regression identified persistent baseline significant SMR as an independent predictor of 2-year clinical worsening (hazard ratio: 2.12, 95% CI: 1.25–3.58, p = 0.005). Significant baseline secondary mitral regurgitation increases the risk of long-term adverse events post-TAVI, although mechanical offloading induces spontaneous valvular improvement in over half of the surviving cohort.
Keywords: Aortic stenosis, Transcatheter aortic valve implantation, Secondary mitral regurgitation, Heart failure, Mortality, Valvular remodeling
Received: November 10, 2023; Revised: December 19, 2023; Accepted: January 11, 2024; Published: February 20, 2024