Impact of moderate to severe mitral stenosis in patients undergoing transcatheter aortic valve replacement.
OBJECTIVE
In patients with severe aortic stenosis (AS) undergoing transcatheter aortic valve replacement (TAVR), the impact of concomitant mitral stenosis (MS) remains unknown. The aim of this study was to determine the incidence and impact of moderate to severe MS in patients undergoing TAVR.


METHODS
The study included 2113 consecutive patients (mean age: 80 ± 9 years, mean STS: 6.4 ± 5.2%) who underwent TAVR in 2 centers. The presence of MS was defined as a mean transmitral gradient ≥ 5 mm Hg on baseline echocardiography in the absence of severe mitral regurgitation. Clinical events were prospectively collected in a dedicated TAVR database.


RESULTS
A total of 157 patients (7.4%) had moderate to severe MS (mean gradient: 7.2 ± 2.8 mm Hg; degenerative origin in 88%). Patients with MS were younger, more frequently women, had a higher left ventricular ejection fraction and an increased rate of severe pulmonary hypertension (p < 0.02 for all). Thirty-day mortality was similar in both groups (MS: 3.8%; no MS: 5.5%, adjusted p = 0.34). At a mean follow-up of 3 ± 2 years, there were no differences between groups in mortality (MS: 35%, no MS: 36.2%, adjusted HR: 1.14, 95% CI: 0.86-1.51), or heart failure rehospitalization (MS: 21%, no MS: 21.7%; adjusted HR: 1.16, 95% CI: 0.81-1.67). Patients with MS exhibited a similar functional status at follow-up compared to those with no MS (NYHA I-II in 85% and 88% of patients, respectively, adjusted p = 0.20).


CONCLUSIONS
About 7% of patients undergoing TAVR had concomitant moderate to severe MS. The presence of MS had no negative impact on early and mid-term clinical outcomes post-TAVR. These results suggest that TAVR is a valid alternative for treating patients with aortic stenosis in the presence of moderate to severe MS.
['Fischer|Quentin|Q|', 'Himbert|Dominique|D|', 'Bernier|Mathieu|M|', 'Urena|Marina|M|', 'Nunes Ferreira-Neto|Alfredo|A|', 'Paradis|Jean-Michel|JM|', 'Mohammadi|Siamak|S|', 'Iung|Bernard|B|', 'Rodés-Cabau|Josep|J|']
D000368:Aged D000369:Aged, 80 and over D001021:Aortic Valve D001024:Aortic Valve Stenosis D015897:Comorbidity D004452:Echocardiography D005260:Female D005602:France D006801:Humans D008297:Male D008943:Mitral Valve D008946:Mitral Valve Stenosis D012189:Retrospective Studies D012307:Risk Factors D012720:Severity of Illness Index D065467:Transcatheter Aortic Valve Replacement
Mitral stenosis Transcatheter aortic valve replacement