Percutaneous edge-to-edge mitral-valve repair (PMVR) may improve prognosis in patients with continuing mitral regurgitation (MR) following transcatheter aortic-valve replacement (TAVR), but further study is required, according to an international group of researchers. The prevalence of significant MR in patients undergoing TAVR is about 25%, Dr. Guy Witberg of Rabin Medical Center, in Petach-Tikva, Israel, and colleagues note in JACC: Cardiovascular Interventions. Although the MR grade will improve following the procedure in about half of these patients, its continued presence after TAVR is tied to higher mortality. PMVR, the authors add, has shown a high procedural success rate, and is associated with a significant improvement in MR grade and NYHA class up to one year of follow-up. To help assess the prognostic effect of residual MR following TAVR and the potential impact of PMVR, the researchers examined registry data on more than 7,300 patients. At baseline, 27% had significant MR, which persisted in 56% after TAVR. Four-year mortality was 44% in patients with MR persistence versus 35% in those with MR regression after TAVR; it was 32% in those without significant baseline MR. To examine the possible effect of a staged TAVR along with PMVR the team assembled a propensity-score-matched cohort involving 91 pairs of patients with significant MR persistence following TAVR who did or did not undergo PMVR. The staged mitral intervention was associated with a better functional class through one year with 82% of these patients achieving NYHA I/II compared to 33% of those who did not undergo PMVR (P<0.001). Four-year mortality was numerically lower (in patients who had the intervention, but the difference was not significant (38% vs. 65%, P=0.097). "These patients may benefit from a staged transcatheter mitral intervention, but this requires further proof from future studies," the researchers conclude. Dr. Hani Jneid of Baylor College of Medicine, in Houston, Texas, who coauthored an accompanying editorial, told Reuters Health by email, "Mixed valve disease always represents a diagnostic and therapeutic challenge. The registry data by Witberg and colleagues provides important insights regarding the treatment of MR after TAVR." "Based on their data," he added, "clinicians should reassess MR severity post-TAVR and in those patients with significant pre-procedural MR who did not show improvement while on optimal guideline-directed medical therapies - approximately 55% - a staged (mitral-valve repair) procedure is reasonable." Dr. Witberg did not respond to requests for comment. —David Douglas Source
