Significant mitral regurgitation is not an absolute contraindication for TAVI

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According to M Zeeshan Khawaja (The Rayne Institute, King’s College London & St Thomas’ Hospital, London, UK), transcatheter aortic valve implantation (TAVI) is not contraindicated in patients with significant mitral regurgitation because more than half of patients with the condition saw an improvement in mitral regurgitation grade after undergoing TAVI.

Speaking at PCR London Valves (15–17 September, London, UK), Khawaja commented that a significant number of patients with severe aortic stenosis who undergo TAVI also have mitral regurgitation and these patients are thought to have greater comorbidities than those without mitral regurgitation. Therfore, he and his fellow investigators conducted a retrospective analysis of patients undergoing TAVI at their centre between March 2008 and December 2012 to “identify the impact of TAVI using the Edwards Sapien bioprosthesis and to determine the effects of residual mitral regurgitation upon outcome after TAVI.”


Of the 317 patients in the analysis, 60 had significant mitral regurgitation (defined as moderate or worse)—the majority (90%) had grade 3 mitral regurgitation with the remainder having grade 4 (10%). Twenty per cent of patients with significant mitral regurgitation had New York Heart Association class IV heart failure compared with 7.4% of those without significant mitral regurgitation (p=0.042), and patients with significant mitral regurgitation also had a lower left ventricular ejection fraction score (44±14.5 vs. 50.4±11.8 for those without significant mitral regurgitation; p=0.002).   


Khawaja said that at 30 days, there were no differences in the effectiveness of TAVI, for aortic stenosis, between groups. He added that after the TAVI procedure, overall, 34.2% of patients saw an improvement in mitral regurgitation by ≥1 grade. “In the 60 patients with significant mitral regurgitation pre-TAVI, 54.1% no longer had significant mitral regurgitation afterwards and no patients worsened,” Khawaja noted. However, 26.5% of patients in the whole population saw deterioration by grade ≥1.  


Summarising his results, the presenter commented: “Significant mitral regurgitation confers greater 12-month mortality. But, over half of patients with significant mitral regurgitation see an improvement in mitral regurgitation after TAVI. Therefore, significant mitral regurgitation should not be an absolute contraindication to TAVI.”