scholarly journals The Common Combination of Aortic Stenosis with Mitral Regurgitation: Diagnostic Insight and Therapeutic Implications in the Modern Era of Advanced Echocardiography and Percutaneous Intervention

2021 ◽  
Vol 10 (19) ◽  
pp. 4364
Author(s):  
Francesca Mantovani ◽  
Andrea Barbieri ◽  
Alessandro Albini ◽  
Niccolò Bonini ◽  
Diego Fanti ◽  
...  
Keyword(s):  
Mitral Regurgitation ◽  
Aortic Stenosis ◽  
Valve Replacement ◽  
Multimodality Imaging ◽  
Therapeutic Implications ◽  
Transcatheter Aortic Valve ◽  
Transcatheter Mitral Valve Replacement ◽  
Diagnostic Framework ◽  
Complex Scenario ◽  
Valve Diseases

The combination of aortic stenosis (AS) and mitral regurgitation (MR) is common in patients with degenerative valvular disease. It is characterized by having complex pathophysiology, leading to potential diagnostic pitfalls. Evidence is scarce in the literature to direct the diagnostic framework and treatment of patients with this particular combination of multiple valvular diseases. In this complex scenario, the appropriate use of advanced echocardiography and multimodality imaging methods plays a central role. Transcatheter mitral valve replacement or repair and transcatheter aortic valve replacement widen the surgical options for valve diseases. Therefore, there is an increasing need to reconsider the function, timing, and mode intervention for patients with a combination of AS with MR towards more personalized treatment.

scholarly journals Prognosis of persistent mitral regurgitation in patients undergoing transcatheter aortic valve replacement

2020 ◽  
Vol 109 (10) ◽  
pp. 1261-1270 ◽  
Author(s):  
Victor Mauri ◽  
Maria I. Körber ◽  
Elmar Kuhn ◽  
Tobias Schmidt ◽  
Christian Frerker ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Mitral Regurgitation ◽  
Aortic Stenosis ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Transcatheter Aortic Valve Replacement ◽  
Severe Aortic Stenosis ◽  
Transcatheter Aortic Valve ◽  
The Impact

Abstract Objective The objective of this study was to assess imaging predictors of mitral regurgitation (MR) improvement and to evaluate the impact of MR regression on long-term outcome in patients undergoing transcatheter aortic valve replacement (TAVR). Background Concomitant MR is a frequent finding in patients with severe aortic stenosis but usually left untreated at the time of TAVR. Methods Mitral regurgitation was graded by transthoracic echocardiography before and after TAVR in 677 consecutive patients with severe aortic stenosis. 2-year mortality was related to the degree of baseline and discharge MR. Morphological echo analysis was performed to determine predictors of MR improvement. Results 15.2% of patients presented with baseline MR ≥ 3 +, which was associated with a significantly decreased 2-year survival (57.7% vs. 74.4%, P < 0.001). MR improved in 50% of patients following TAVR, with 44% regressing to MR ≤ 2 +. MR improvement to ≤ 2 + was associated with significantly better survival compared to patients with persistent MR ≥ 3 +. Baseline parameters including non-severe baseline MR, the extent of mitral annular calcification and large annular dimension (≥ 32 mm) predicted the likelihood of an improvement to MR ≤ 2 +. A score based on these parameters selected groups with differing probability of MR ≤ 2 + post TAVR ranging from 10.5 to 94.4% (AUC 0.816; P < 0.001), and was predictive for 2-year mortality. Conclusion Unresolved severe MR is a critical determinant of long term mortality following TAVR. Persistence of severe MR following TAVR can be predicted using selected parameters derived from TTE-imaging. These data call for close follow up and additional mitral valve treatment in this subgroup. Graphic abstract Factors associated with MR persistence or regression after TAVR

scholarly journals Transcatheter Aortic Valve Replacement in Patients With Aortic Stenosis and Mitral Regurgitation

2017 ◽  
Vol 104 (6) ◽  
pp. 1977-1985 ◽  
Author(s):  
Kreton Mavromatis ◽  
Vinod H. Thourani ◽  
Amanda Stebbins ◽  
Sreekanth Vemulapalli ◽  
Chandan Devireddy ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Mitral Regurgitation ◽  
Aortic Stenosis ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Transcatheter Aortic Valve Replacement ◽  
Transcatheter Aortic Valve

scholarly journals Mixed-Valve Disease: Management of Patients with Aortic Stenosis and Mitral Regurgitation: Thresholds for Surgery Versus Percutaneous Therapies

2021 ◽  
Vol 15 ◽  
Author(s):  
Jean-Bernard Masson ◽  
Jessica Forcillo
Keyword(s):  
Aortic Valve ◽  
Mitral Regurgitation ◽  
Aortic Stenosis ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Transcatheter Aortic Valve Replacement ◽  
Severe Aortic Stenosis ◽  
Percutaneous Treatment ◽  
Transcatheter Aortic Valve ◽  
Valve Implantation

Significant mitral regurgitation (MR), frequently seen in the presence of severe aortic stenosis (AS), results in an association that negatively affects prognosis and imposes particular challenges for both the assessment of the severity of valvular lesions and decisions regarding treatment allocation. This article reviews the available literature with regards to the assessment of MR and AS in the presence of both; surgical management and results in patients with concomitant AS and MR; the effect of MR on outcomes in patients undergoing transcatheter aortic valve replacement; the effect of transcatheter aortic valve replacement on MR severity; and percutaneous treatment for MR after transcatheter aortic valve implantation. The authors aim to provide assistance in the decision-making process to treat patients with either a higher-risk double-valve procedure or a simpler, but perhaps incomplete, single-valve option.

Advances in Transcatheter Aortic Valve Therapy in Bicuspid Aortic Valve Disease: Insight into Patient Selection, Management, and Future Directions

2021 ◽  
Vol 39 ◽  
Author(s):  
Valeria Cammalleri ◽  
◽  
Gianpaolo Ussia ◽  
Mario Lusini ◽  
Ciro Mastroianni ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Stenosis ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Bicuspid Aortic Valve ◽  
Aortic Valve Disease ◽  
Multimodality Imaging ◽  
Valve Disease ◽  
Transcatheter Aortic Valve ◽  
Transcatheter Valve

Bicuspid aortic valve (BAV) disease is the most common congenital abnormality and is characterized by a risk of premature aortic valve disease, predominantly aortic stenosis. Surgery remains the treatment of choice for patients with symptomatic BAV disease, but, in patients who are unsuitable for surgical aortic valve replacement, transcatheter aortic valve replacement (TAVR) is currently used as an alternative to surgery, although there is no official recommendation for their management, since BAV patients with severe aortic stenosis have been excluded from the major TAVR randomized clinical trials. Patients with BAV stenosis present anatomic challenges for treatment with TAVR. The BAV annulus often has an elliptical shape and is larger than the tricuspid valve, and is more likely to exhibit severe eccentric calcification. In addition, BAV is often associated with a dilated, horizontal ascending aorta, and effaced sinuses. The calcified raphe may also place differential stress on the expansion of the transcatheter valve, increasing the risk of suboptimal positioning and consequently the risk of paravalvular leakage, new pacemaker implantation, new-onset left bundle branch block, and annular rupture. Moreover, coronary obstruction may occur when leaflet fusion results in a longer leaflet. Although some of these challenges have been successfully overcome using new-generation devices, the complication rate is still relatively high and requires a deeper understanding of the patient’s specific complex and variable anatomy. Selection of the type and size of the transcatheter valve according to the patient’s individual anatomy is critical to achieving successful results. Therefore, given the increasing frequency of BAV stenosis in younger patients, and the worldwide expansion in the application of TAVR in younger and lower surgical-risk patients, preprocedural multimodality imaging involving CT scan and three-dimensional echocardiography is mandatory to understand the complex and variable anatomy of BAV disease and improve both procedural results and short- and long-term outcomes in these patients.

P5576Outcomes and clinical impact of mitral regurgitation in patients with aortic stenosis undergoing with transcatheter aortic valve replacement

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
E Munoz-Garcia ◽  
M Munoz-Garcia ◽  
A J Munoz Garcia ◽  
A J Dominguez-Franco ◽  
F Carrasco-Chinchilla ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Mitral Regurgitation ◽  
Aortic Stenosis ◽  
Aortic Valve Replacement ◽  
Clinical Outcomes ◽  
Valve Replacement ◽  
Transcatheter Aortic Valve ◽  
Mitral Repair ◽  
Increased Risk ◽  
Increase Risk

Abstract Background Many patients undergoing Trancatheter aortic valve replacement (TAVR) for aortic stenosis also have significant mitral regurgitation (MR). We sought to understand the association of concomitant MR with TAVR clinical outcomes, as well changes in MR after TAVR. Methods Patients who underwent TAVR at our center, between April 2008 to December 2017, were studied, with longer-term clinical outcomes. Results Of 667patients, 92 (13.8%) had moderate MR, and 47 (2.1%) had severe MR. At 3.2±2.2 years, mortality was 39.4%, 46.1%, 39.1%, 57.6% and 50% and heart failure (HF) rehospitalization was 7%, 7.9%, 17.6%, 21.9% and 46.2% (p<0.001) in the no, mild, moderate, moderate-severe and severe MR patients, respectively. After procedure, 64 patients (9.9%) had moderate MR and 24 patients (3.7%) had severe MR. At follow-up, the mortality was 35.9%, 46.5%, 48.4%, 52.9% and 85.7%, p<0.001 and HF rehospitalization 9.1%, 5.5%, 23.4%, 35.3% and 40% in the no, mild, moderate, moderate-severe and severe MR patients, respectively. MR improved early after TAVI grade in 88 patients (13.2%). Baseline MR is not associated with mortality (HR= 0.883 [95 CI 0.708–1.102], p=0.114), but MR post-TAVR was associated with increase risk of mortality (HR= 1.539 [95 CI 1.187–1.996], p=0.001. In 7 patients with persistent MR received percutaneous mitral repair with MitraClip®. Conclusions In our series, Moderate or severe MR after TAVR is associated with increased mortality or HF rehospitalization, this increased risk may be attributable to the minority of patients whose MR does not improve and could benefit from percutaneous mitral procedures (Mitraclip®).

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