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2015 ; 13
(ä): 49
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The beneficial effects of TAVI in mitral insufficiency
#MMPMID26714887
Costantino MF
; Dores E
; Innelli P
; Matera A
; Santillo V
; Violini R
; Fiorilli R
; Cappabianca G
; Marraudino N
; Picano E
; Tarsia G
Cardiovasc Ultrasound
2015[Dec]; 13
(ä): 49
PMID26714887
show ga
BACKGROUND: Previous studies have suggested that concomitant mitral regurgitation
(MR) is a risk factor for acute transcatheter aortic valve implantation (TAVI)
failure, but may improve afterwards. Aim of this study was to assess the
prevalence, clinical meaning and modifications of MR in patients undergoing TAVI.
METHODS: In a retrospective, two-center (Potenza-San Carlo and Roma- San Camillo)
study, from January 2010 to June 2014 we enrolled 165 consecutive patients (age
=80?±?5 years, 74 males, Ejection Fraction 51?±?9 %) referred for TAVI with
either Medtronic Core-ReValving System (in 114 patients, 69%) or
balloon-expandable Edwards SAPIEN/SAPIEN XT (in 51 patients, 31%). All patients
underwent TTE and TEE assessment of MR (from 1, mild to 4?=?severe according to
ESC latest guidelines) with core lab reading by a single observer blinded to
patient identity and status. Assessment was performed at baseline (24 h prior to
intervention) and at 1, 6, 12 and 24 months. RESULTS: Mild-to-Moderate MR (grade
1-2) was present in 137 patients and Moderate-to-Severe MR (grade 3-4) was
present in 28 patients. No significant differences were seen comparing
perioperative mortality and morbidity between the two groups. In the group of
preoperative MR grade 3-4 the mean decrease from MR pre-TAVI to MR at 1 month
post-TAVI was 0.464 (p?0.0001) and this improvement was persistent at 6 months
(p?0.0001) and at 12 months (p?0.0001), with partial benefit loss at 1 and 2
years. The mean difference from Left Atrial volume post-TAVI at 1 month was 16.5
ml (p?0.0001) and this improvement was persistent at 12 months 12.12 ml
(p?0.0001). CONCLUSIONS: TAVI effectively treats the aortic valve but as a
beneficial by product also ameliorates concomitant MR. The presence of
moderate-to-severe MR does not increase the acute risk of failure of TAVI. In
successful procedures, the MR improves immediately and persistently.