Impact of concomitant mitral regurgitation during transcatheter aortic valve replacement on 1-year survival outcomes

Kaoru Matsuura; Hiraku Kumamaru; Shun Kohsaka; Tomoyoshi Kanda; Daichi Yamashita; Hideki Kitahara; Kazuo Shimamura; Yoshio Kobayashi; Goro Matsumiya

doi:10.1016/j.jjcc.2023.01.002

Impact of concomitant mitral regurgitation during transcatheter aortic valve replacement on 1-year survival outcomes

J Cardiol. 2023 Jul;82(1):16-21. doi: 10.1016/j.jjcc.2023.01.002. Epub 2023 Jan 20.

Authors

Kaoru Matsuura¹, Hiraku Kumamaru², Shun Kohsaka³, Tomoyoshi Kanda⁴, Daichi Yamashita⁵, Hideki Kitahara⁵, Kazuo Shimamura⁶, Yoshio Kobayashi⁵, Goro Matsumiya⁴

Affiliations

¹ Department of Cardiovascular Surgery, Chiba University Graduate School of Medicine, Chiba, Japan. Electronic address: km4717jp@yahoo.co.jp.
² Department of Healthcare Quality Assessment, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
³ Department of Cardiology, Keio University School of Medicine, Tokyo, Japan.
⁴ Department of Cardiovascular Surgery, Chiba University Graduate School of Medicine, Chiba, Japan.
⁵ Department of Cardiology, Chiba University Graduate School of Medicine, Chiba, Japan.
⁶ Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Suita, Japan.

PMID: 36682712
DOI: 10.1016/j.jjcc.2023.01.002

Abstract

Background: We investigated the influence of concomitant mitral regurgitation (MR) in patients undergoing transcatheter aortic valve implantation on the 1-year outcome using Japan Transcatheter Valve Therapy (J-TVT) registry data.

Methods: The patients who underwent the transcatheter aortic valve implantation for aortic stenosis performed from August 2013 to December 2019 in Japan were included. History of previous valve surgery and dialysis patients were excluded. A total of 24,979 patients were included, and 1-year follow-up data were obtained from the registry (follow-up rate 98.5 %). Propensity-score matching, using multivariable logistic regression and 1:1 matching without replacement, was performed between the patients with grade 3-4 MR (MR 3-4 group) and those with grade 0-2 MR (MR 0-2 group). All-cause death and the composite outcome of death and/or heart failure events were compared.

Results: After propensity score matching, 3920 cases (1960 cases each in MR 0-2 group and MR 3-4 group) were extracted. The procedure success rate was 96.4 % in MR 0-2 and 96.0 % in MR 3-4 group (p = 0.56) and the surgical conversion rate was 0.7 % in MR 0-2 group and 0.8 % in MR 3-4 group (p = 0.58). Cox regression model showed no statistical difference in 1-year survival rate between MR 0-2 group (89.4 %) and MR 3-4 group (89.6 %) (p = 0.80). However, freedom from 1-year death and/or heart failure event was lower in MR 3-4 (86.3 %) than in MR 0-2 group (88.9 %) (p = 0.01). This trend was also found in the subgroup of New York Heart Association (NYHA) class 1-2 but not in the subgroup of NYHA class 3-4.

Conclusions: One-year survival rate was not different between groups but freedom from death and/or heart failure events was lower in patients with preoperative MR grade 3-4 than in patients with preoperative MR grade 0-2 after transcatheter aortic valve replacement.

Keywords: Aortic valve replacement/implantation; Outcomes; Prognosis; Transcatheter.

MeSH terms

Aortic Valve / surgery
Aortic Valve Stenosis*
Heart Failure* / complications
Heart Valve Prosthesis Implantation* / methods
Humans
Mitral Valve Insufficiency* / etiology
Retrospective Studies
Severity of Illness Index
Transcatheter Aortic Valve Replacement* / methods
Treatment Outcome