Effect of mitral regurgitation on transcatheter aortic valve replacement_West China Medical Journal

Authors：

TANG Rui ^1,2 , XU Chengyi ³ , SUN Mengqi ³ ,  SONG Dan ³

1. Department of Ultrasound Imaging Ⅱ, the Central Hospital of Enshi TUJIA and MIAO Autonomous Prefecture, Enshi, Hubei 445000, P. R. China;
2. School of Medicine, Wuhan University of Science and Technology, Wuhan, Hubei 430081, P. R. China;
3. Department of Cardiology, Wuhan Asian Heart Hospital, Wuhan University of Science and Technology, Wuhan, Hubei 430022, P. R. China;

Corresponding author：

SONG Dan, Email: Songdan8300@163.com

Keywords：

Transcatheter aortic valve replacement; mitral incompetence; aortic stenosis; mitral valve repair

DOI：

10.7507/1002-0179.202101218

Video：

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With the expanding indications for transcatheter aortic valve replacement (TAVR) guidelines, combined valvular disease is often encountered in the clinic, and existing relevant studies have shown that preoperative moderate to severe mitral regurgitation is associated with higher mortality. In these patients, the optimal treatment strategy for TAVR with evidence-based heart failure, TAVR with transcatheter mitral intervention, or staging transcatheter therapy are unclear. Therefore, a comprehensive assessment of the anatomy and function of the aortic and mitral valves, as well as an in-depth assessment of the patient’s baseline risk profile, are the basis for an individualized approach to treatment. This article will review the results of the relevant research to better help clinicians diagnose and treat relevant patients.

Citation： TANG Rui, XU Chengyi, SUN Mengqi, SONG Dan. Effect of mitral regurgitation on transcatheter aortic valve replacement. West China Medical Journal, 2022, 37(4): 604-609. doi: 10.7507/1002-0179.202101218 Copy

1.	Iung B, Cachier A, Baron G, et al. Decision-making in elderly patients with severe aortic stenosis: why are so many denied surgery?. Eur Heart J, 2005, 26(24): 2714-2720.
2.	Reardon MJ, Van Mieghem NM, Popma JJ, et al. Surgical or transcatheter aortic-valve replacement in intermediate-risk patients. N Engl J Med, 2017, 376(14): 1321-1331.
3.	Mack MJ, Leon MB, Thourani VH, et al. Transcatheter aortic-valve replacement with a balloon-expandable valve in low-risk patients. N Engl J Med, 2019, 380(18): 1695-1705.
4.	Ielasi A, Latib A, Tespili M, et al. Current results and remaining challenges of trans-catheter aortic valve replacement expansion in intermediate and low risk patients. Int J Cardiol Heart Vasc, 2019, 23: 100375.
5.	Popma JJ, Deeb GM, Yakubov SJ, et al. Transcatheter aortic-valve replacement with a self-expanding valve in low-risk patients. N Engl J Med, 2019, 380(18): 1706-1715.
6.	Nombela-Franco L, Ribeiro HB, Urena M, et al. Significant mitral regurgitation left untreated at the time of aortic valve replacement: a comprehensive review of a frequent entity in the transcatheter aortic valve replacement era. J Am Coll Cardiol, 2014, 63(24): 2643-2658.
7.	Sannino A, Grayburn PA. Mitral regurgitation in patients with severe aortic stenosis: diagnosis and management. Heart, 2018, 104(1): 16-22.
8.	Nappi F, Carotenuto AR, Avtaar Singh SS, et al. Euler’s elastica-based biomechanics of the papillary muscle approximation in ischemic mitral valve regurgitation: a simple 2D analytical model. Materials (Basel), 2019, 12(9): 1518.
9.	Nappi F, Spadaccio C, Mihos CG, et al. Euler’s elastica-based biomechanical assessment for neochordal insertion in the treatment of degenerative mitral valve repair. J Thorac Cardiovasc Surg, 2018, 155(2): 603-605.
10.	Baumgartner H, Falk V, Bax JJ, et al. 2017 ESC/EACTS guidelines for the management of valvular heart disease. Rev Esp Cardiol (Engl Ed), 2018, 71(2): 110.
11.	Zoghbi WA, Adams D, Bonow RO, et al. Recommendations for noninvasive evaluation of native valvular regurgitation: a report from the american society of echocardiography developed in collaboration with the society for cardiovascular magnetic resonance. J Am Soc Echocardiogr, 2017, 30(4): 303-371.
12.	Grayburn PA, Carabello B, Hung J, et al. Defining “severe” secondary mitral regurgitation: emphasizing an integrated approach. J Am Coll Cardiol, 2014, 64(25): 2792-2801.
13.	Katte F, Franz M, Jung C, et al. Impact of concomitant mitral regurgitation on transvalvular gradient and flow in severe aortic stenosis: a systematic ex vivo analysis of a subentity of low-flow low-gradient aortic stenosis. EuroIntervention, 2018, 13(14): 1635-1644.
14.	中国医师协会超声分会超声心动图专业委员会, 中华医学会超声医学分会超声心动图学组, 中华医学会心血管病分会结构性心脏病学组, 等. 二尖瓣反流介入治疗的超声心动图评价中国专家共识. 中国介入心脏病学杂志, 2019, 27(1): 6-12.
15.	Blanke P, Naoum C, Webb J, et al. Multimodality imaging in the context of transcatheter mitral valve replacement: establishing consensus among modalities and disciplines. JACC Cardiovasc Imaging, 2015, 8(10): 1191-1208.
16.	Eleid MF, Foley TA, Said SM, et al. Severe mitral annular calcification: multimodality imaging for therapeutic strategies and interventions. JACC Cardiovasc Imaging, 2016, 9(11): 1318-1337.
17.	Winter MP, Bartko PE, Krickl A, et al. Adaptive development of concomitant secondary mitral and tricuspid regurgitation after transcatheter aortic valve replacement. Eur Heart J Cardiovasc Imaging, 2021, 22(9): 1045-1053.
18.	Miura M, Yamaji K, Shirai S, et al. Clinical impact of preprocedural moderate or severe mitral regurgitation on outcomes after transcatheter aortic valve replacement. Can J Cardiol, 2020, 36(7): 1112-1120.
19.	Barbanti M, Webb JG, Hahn RT, et al. Impact of preoperative moderate/severe mitral regurgitation on 2-year outcome after transcatheter and surgical aortic valve replacement: insight from the placement of aortic transcatheter valve (PARTNER) trial cohort A. Circulation, 2013, 128(25): 2776-2784.
20.	Lauten A, Figulla HR, Möllmann H, et al. TAVI for low-flow, low-gradient severe aortic stenosis with preserved or reduced ejection fraction: a subgroup analysis from the german aortic valve registry (GARY). EuroIntervention, 2014, 10(7): 850-859.
21.	Freitas-Ferraz AB, Lerakis S, Barbosa Ribeiro H, et al. Mitral regurgitation in low-flow, low-gradient aortic stenosis patients undergoing TAVR: insights from the TOPAS-TAVI registry. JACC Cardiovasc Interv, 2020, 13(5): 567-579.
22.	Nombela-Franco L, Eltchaninoff H, Zahn R, et al. Clinical impact and evolution of mitral regurgitation following transcatheter aortic valve replacement: a meta-analysis. Heart, 2015, 101(17): 1395-1405.
23.	Cortés C, Amat-Santos IJ, Nombela-Franco L, et al. Mitral regurgitation after transcatheter aortic valve replacement: prognosis, imaging predictors, and potential management. JACC Cardiovasc Interv, 2016, 9(15): 1603-1614.
24.	O’Sullivan CJ, Stortecky S, Bütikofer A, et al. Impact of mitral regurgitation on clinical outcomes of patients with low-ejection fraction, low-gradient severe aortic stenosis undergoing transcatheter aortic valve implantation. Circ Cardiovasc Interv, 2015, 8(2): e001895.
25.	Sannino A, Losi MA, Schiattarella GG, et al. Meta-analysis of mortality outcomes and mitral regurgitation evolution in 4,839 patients having transcatheter aortic valve implantation for severe aortic stenosis. Am J Cardiol, 2014, 114(6): 875-882.
26.	Feldt K, De Palma R, Bjursten H, et al. Change in mitral regurgitation severity impacts survival after transcatheter aortic valve replacement. Int J Cardiol, 2019, 294: 32-36.
27.	Medranda GA, Schwartz R, Green SJ. Predictors and outcome impact of mitral regurgitation in transcatheter aortic valve replacement. Cardiovasc Revasc Med, 2021, 32: 35-40.
28.	Unger P, Dedobbeleer C, Vanden Eynden F, et al. Mitral regurgitation after transcatheter aortic valve replacement: does the prosthesis matter?. Int J Cardiol, 2013, 168(2): 1706-1709.
29.	Giordana F, Capriolo M, Frea S, et al. Impact of TAVI on mitral regurgitation: a prospective echocardiographic study. Echocardiography, 2013, 30(3): 250-257.
30.	Matsumura Y, Gillinov AM, Toyono M, et al. Echocardiographic predictors for persistent functional mitral regurgitation after aortic valve replacement in patients with aortic valve stenosis. Am J Cardiol, 2010, 106(5): 701-706.
31.	Vanden Eynden F, Bouchard D, El-Hamamsy I, et al. Effect of aortic valve replacement for aortic stenosis on severity of mitral regurgitation. Ann Thorac Surg, 2007, 83(4): 1279-1284.
32.	Durst R, Avelar E, McCarty D, et al. Outcome and improvement predictors of mitral regurgitation after transcatheter aortic valve implantation. J Heart Valve Dis, 2011, 20(3): 272-281.
33.	Van Belle E, Juthier F, Susen S, et al. Postprocedural aortic regurgitation in balloon-expandable and self-expandable transcatheter aortic valve replacement procedures: analysis of predictors and impact on long-term mortality: insights from the FRANCE2 registry. Circulation, 2014, 129(13): 1415-1427.
34.	Yancy CW, Jessup M, Bozkurt B, et al. 2017 ACC/AHA/HFSA focused update of the 2013 ACCF/AHA guideline for the management of heart failure: a report of the American College of Cardiology/American Heart Association task force on clinical practice guidelines and the heart failure society of America. J Card Fail, 2017, 23(8): 628-651.
35.	Nishimura RA, Otto CM, Bonow RO, et al. 2017 AHA/ACC focused update of the 2014 AHA/ACC guideline for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association task force on clinical practice guidelines. J Am Coll Cardiol, 2017, 70(2): 252-289.
36.	Vahanian A, Alfieri O, Andreotti F, et al. Guidelines on the management of valvular heart disease (version 2012): the Joint task force on the management of valvular heart disease of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS). Eur J Cardiothorac Surg, 2012, 42(4): S1-S44.
37.	Vassileva CM, Li S, Thourani VH, et al. Outcome characteristics of multiple-valve surgery: comparison with single-valve procedures. Innovations (Phila), 2014, 9(1): 27-32.
38.	Aortic Stenosis Writing Group, Bonow RO, Brown AS, et al. ACC/AATS/AHA/ASE/EACTS/HVS/SCA/SCAI/SCCT/SCMR/STS 2017 appropriate use criteria for the treatment of patients with severe aortic stenosis. Eur J Cardiothorac Surg, 2018, 53(2): 306-308y.
39.	De Bonis M, Maisano F, La Canna G, et al. Treatment and management of mitral regurgitation. Nat Rev Cardiol, 2011, 9(3): 133-146.
40.	Ben-Assa E, Biner S, Banai S, et al. Clinical impact of post procedural mitral regurgitation after transcatheter aortic valve replacement. Int J Cardiol, 2020, 299: 215-221.
41.	Abdelghani M, Abdel-Wahab M, Hemetsberger R, et al. Fate and long-term prognostic implications of mitral regurgitation in patients undergoing transcatheter aortic valve replacement. Int J Cardiol, 2019, 288: 39-43.
42.	Yoon SH, Whisenant BK, Bleiziffer S, et al. Transcatheter mitral valve replacement for degenerated bioprosthetic valves and failed annuloplasty rings. J Am Coll Cardiol, 2017, 70(9): 1121-1131.
43.	Glower DD, Kar S, Trento A, et al. Percutaneous mitral valve repair for mitral regurgitation in high-risk patients: results of the EVEREST Ⅱ study. J Am Coll Cardiol, 2014, 64(2): 172-181.
44.	Braun D, Lesevic H, Orban M, et al. Percutaneous edge-to-edge repair of the mitral valve in patients with degenerative versus functional mitral regurgitation. Catheter Cardiovasc Interv, 2014, 84(1): 137-146.
45.	刘欢, 刘顺, 魏来, 等. 2020 更新版《ACC 二尖瓣关闭不全管理途径专家共识》解读. 中国胸心血管外科临床杂志, 2020, 27(12): 1389-1392.

1. Iung B, Cachier A, Baron G, et al. Decision-making in elderly patients with severe aortic stenosis: why are so many denied surgery?. Eur Heart J, 2005, 26(24): 2714-2720.
2. Reardon MJ, Van Mieghem NM, Popma JJ, et al. Surgical or transcatheter aortic-valve replacement in intermediate-risk patients. N Engl J Med, 2017, 376(14): 1321-1331.
3. Mack MJ, Leon MB, Thourani VH, et al. Transcatheter aortic-valve replacement with a balloon-expandable valve in low-risk patients. N Engl J Med, 2019, 380(18): 1695-1705.
4. Ielasi A, Latib A, Tespili M, et al. Current results and remaining challenges of trans-catheter aortic valve replacement expansion in intermediate and low risk patients. Int J Cardiol Heart Vasc, 2019, 23: 100375.
5. Popma JJ, Deeb GM, Yakubov SJ, et al. Transcatheter aortic-valve replacement with a self-expanding valve in low-risk patients. N Engl J Med, 2019, 380(18): 1706-1715.
6. Nombela-Franco L, Ribeiro HB, Urena M, et al. Significant mitral regurgitation left untreated at the time of aortic valve replacement: a comprehensive review of a frequent entity in the transcatheter aortic valve replacement era. J Am Coll Cardiol, 2014, 63(24): 2643-2658.
7. Sannino A, Grayburn PA. Mitral regurgitation in patients with severe aortic stenosis: diagnosis and management. Heart, 2018, 104(1): 16-22.
8. Nappi F, Carotenuto AR, Avtaar Singh SS, et al. Euler’s elastica-based biomechanics of the papillary muscle approximation in ischemic mitral valve regurgitation: a simple 2D analytical model. Materials (Basel), 2019, 12(9): 1518.
9. Nappi F, Spadaccio C, Mihos CG, et al. Euler’s elastica-based biomechanical assessment for neochordal insertion in the treatment of degenerative mitral valve repair. J Thorac Cardiovasc Surg, 2018, 155(2): 603-605.
10. Baumgartner H, Falk V, Bax JJ, et al. 2017 ESC/EACTS guidelines for the management of valvular heart disease. Rev Esp Cardiol (Engl Ed), 2018, 71(2): 110.
11. Zoghbi WA, Adams D, Bonow RO, et al. Recommendations for noninvasive evaluation of native valvular regurgitation: a report from the american society of echocardiography developed in collaboration with the society for cardiovascular magnetic resonance. J Am Soc Echocardiogr, 2017, 30(4): 303-371.
12. Grayburn PA, Carabello B, Hung J, et al. Defining “severe” secondary mitral regurgitation: emphasizing an integrated approach. J Am Coll Cardiol, 2014, 64(25): 2792-2801.
13. Katte F, Franz M, Jung C, et al. Impact of concomitant mitral regurgitation on transvalvular gradient and flow in severe aortic stenosis: a systematic ex vivo analysis of a subentity of low-flow low-gradient aortic stenosis. EuroIntervention, 2018, 13(14): 1635-1644.
14. 中国医师协会超声分会超声心动图专业委员会, 中华医学会超声医学分会超声心动图学组, 中华医学会心血管病分会结构性心脏病学组, 等. 二尖瓣反流介入治疗的超声心动图评价中国专家共识. 中国介入心脏病学杂志, 2019, 27(1): 6-12.
15. Blanke P, Naoum C, Webb J, et al. Multimodality imaging in the context of transcatheter mitral valve replacement: establishing consensus among modalities and disciplines. JACC Cardiovasc Imaging, 2015, 8(10): 1191-1208.
16. Eleid MF, Foley TA, Said SM, et al. Severe mitral annular calcification: multimodality imaging for therapeutic strategies and interventions. JACC Cardiovasc Imaging, 2016, 9(11): 1318-1337.
17. Winter MP, Bartko PE, Krickl A, et al. Adaptive development of concomitant secondary mitral and tricuspid regurgitation after transcatheter aortic valve replacement. Eur Heart J Cardiovasc Imaging, 2021, 22(9): 1045-1053.
18. Miura M, Yamaji K, Shirai S, et al. Clinical impact of preprocedural moderate or severe mitral regurgitation on outcomes after transcatheter aortic valve replacement. Can J Cardiol, 2020, 36(7): 1112-1120.
19. Barbanti M, Webb JG, Hahn RT, et al. Impact of preoperative moderate/severe mitral regurgitation on 2-year outcome after transcatheter and surgical aortic valve replacement: insight from the placement of aortic transcatheter valve (PARTNER) trial cohort A. Circulation, 2013, 128(25): 2776-2784.
20. Lauten A, Figulla HR, Möllmann H, et al. TAVI for low-flow, low-gradient severe aortic stenosis with preserved or reduced ejection fraction: a subgroup analysis from the german aortic valve registry (GARY). EuroIntervention, 2014, 10(7): 850-859.
21. Freitas-Ferraz AB, Lerakis S, Barbosa Ribeiro H, et al. Mitral regurgitation in low-flow, low-gradient aortic stenosis patients undergoing TAVR: insights from the TOPAS-TAVI registry. JACC Cardiovasc Interv, 2020, 13(5): 567-579.
22. Nombela-Franco L, Eltchaninoff H, Zahn R, et al. Clinical impact and evolution of mitral regurgitation following transcatheter aortic valve replacement: a meta-analysis. Heart, 2015, 101(17): 1395-1405.
23. Cortés C, Amat-Santos IJ, Nombela-Franco L, et al. Mitral regurgitation after transcatheter aortic valve replacement: prognosis, imaging predictors, and potential management. JACC Cardiovasc Interv, 2016, 9(15): 1603-1614.
24. O’Sullivan CJ, Stortecky S, Bütikofer A, et al. Impact of mitral regurgitation on clinical outcomes of patients with low-ejection fraction, low-gradient severe aortic stenosis undergoing transcatheter aortic valve implantation. Circ Cardiovasc Interv, 2015, 8(2): e001895.
25. Sannino A, Losi MA, Schiattarella GG, et al. Meta-analysis of mortality outcomes and mitral regurgitation evolution in 4,839 patients having transcatheter aortic valve implantation for severe aortic stenosis. Am J Cardiol, 2014, 114(6): 875-882.
26. Feldt K, De Palma R, Bjursten H, et al. Change in mitral regurgitation severity impacts survival after transcatheter aortic valve replacement. Int J Cardiol, 2019, 294: 32-36.
27. Medranda GA, Schwartz R, Green SJ. Predictors and outcome impact of mitral regurgitation in transcatheter aortic valve replacement. Cardiovasc Revasc Med, 2021, 32: 35-40.
28. Unger P, Dedobbeleer C, Vanden Eynden F, et al. Mitral regurgitation after transcatheter aortic valve replacement: does the prosthesis matter?. Int J Cardiol, 2013, 168(2): 1706-1709.
29. Giordana F, Capriolo M, Frea S, et al. Impact of TAVI on mitral regurgitation: a prospective echocardiographic study. Echocardiography, 2013, 30(3): 250-257.
30. Matsumura Y, Gillinov AM, Toyono M, et al. Echocardiographic predictors for persistent functional mitral regurgitation after aortic valve replacement in patients with aortic valve stenosis. Am J Cardiol, 2010, 106(5): 701-706.
31. Vanden Eynden F, Bouchard D, El-Hamamsy I, et al. Effect of aortic valve replacement for aortic stenosis on severity of mitral regurgitation. Ann Thorac Surg, 2007, 83(4): 1279-1284.
32. Durst R, Avelar E, McCarty D, et al. Outcome and improvement predictors of mitral regurgitation after transcatheter aortic valve implantation. J Heart Valve Dis, 2011, 20(3): 272-281.
33. Van Belle E, Juthier F, Susen S, et al. Postprocedural aortic regurgitation in balloon-expandable and self-expandable transcatheter aortic valve replacement procedures: analysis of predictors and impact on long-term mortality: insights from the FRANCE2 registry. Circulation, 2014, 129(13): 1415-1427.
34. Yancy CW, Jessup M, Bozkurt B, et al. 2017 ACC/AHA/HFSA focused update of the 2013 ACCF/AHA guideline for the management of heart failure: a report of the American College of Cardiology/American Heart Association task force on clinical practice guidelines and the heart failure society of America. J Card Fail, 2017, 23(8): 628-651.
35. Nishimura RA, Otto CM, Bonow RO, et al. 2017 AHA/ACC focused update of the 2014 AHA/ACC guideline for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association task force on clinical practice guidelines. J Am Coll Cardiol, 2017, 70(2): 252-289.
36. Vahanian A, Alfieri O, Andreotti F, et al. Guidelines on the management of valvular heart disease (version 2012): the Joint task force on the management of valvular heart disease of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS). Eur J Cardiothorac Surg, 2012, 42(4): S1-S44.
37. Vassileva CM, Li S, Thourani VH, et al. Outcome characteristics of multiple-valve surgery: comparison with single-valve procedures. Innovations (Phila), 2014, 9(1): 27-32.
38. Aortic Stenosis Writing Group, Bonow RO, Brown AS, et al. ACC/AATS/AHA/ASE/EACTS/HVS/SCA/SCAI/SCCT/SCMR/STS 2017 appropriate use criteria for the treatment of patients with severe aortic stenosis. Eur J Cardiothorac Surg, 2018, 53(2): 306-308y.
39. De Bonis M, Maisano F, La Canna G, et al. Treatment and management of mitral regurgitation. Nat Rev Cardiol, 2011, 9(3): 133-146.
40. Ben-Assa E, Biner S, Banai S, et al. Clinical impact of post procedural mitral regurgitation after transcatheter aortic valve replacement. Int J Cardiol, 2020, 299: 215-221.
41. Abdelghani M, Abdel-Wahab M, Hemetsberger R, et al. Fate and long-term prognostic implications of mitral regurgitation in patients undergoing transcatheter aortic valve replacement. Int J Cardiol, 2019, 288: 39-43.
42. Yoon SH, Whisenant BK, Bleiziffer S, et al. Transcatheter mitral valve replacement for degenerated bioprosthetic valves and failed annuloplasty rings. J Am Coll Cardiol, 2017, 70(9): 1121-1131.
43. Glower DD, Kar S, Trento A, et al. Percutaneous mitral valve repair for mitral regurgitation in high-risk patients: results of the EVEREST Ⅱ study. J Am Coll Cardiol, 2014, 64(2): 172-181.
44. Braun D, Lesevic H, Orban M, et al. Percutaneous edge-to-edge repair of the mitral valve in patients with degenerative versus functional mitral regurgitation. Catheter Cardiovasc Interv, 2014, 84(1): 137-146.
45. 刘欢, 刘顺, 魏来, 等. 2020 更新版《ACC 二尖瓣关闭不全管理途径专家共识》解读. 中国胸心血管外科临床杂志, 2020, 27(12): 1389-1392.

West China Medical Journal

Effect of mitral regurgitation on transcatheter aortic valve replacement

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