The beneficial effects of TAVI in mitral insufficiency

Cardiovascular Ultrasound

Research

Vincenza Santillo¹  Giandomenico Tarsia¹  Marco Fabio Costantino¹  Antonella Matera¹  Eugenio Picano²  GianGiuseppe Cappabianca³  Nicola Marraudino⁴  Pasquale Innelli⁵  Ernesta Dores⁶  Roberto Violini⁷  Rosario Fiorilli⁷ 

[1] Cardiology Intensive Care Unit “Alta Specialità del Cuore” Department AORN San Carlo Hospital Potenza, Via Potito Petrone, 85100, Potenza, Italy;Institute of clinical physiology, CNR, Pisa, Italy;UO Cardiac Surgery ,Ospedale di Circolo, Università dell’Insubria, Varese, Italy;UO Cardiac Surgery, Università di BARI, Bari, Italy;UO Cardiology Intensive Care Unit, Villa d’Agri Hospital –ASP, Potenza, Italy;UO Emergency Care, San Giovanni di Dio Hospital Melfi –ASP, Potenza, Italy;UO Interventional Cardiology Unit, S. Camillo Forlanini Hospital, Rome, Italy;

关键词: Mitral regurgitation;    Aortic stenosis;    Transcatheter Aortic Valve Implantation (TAVI);   

DOI  :  10.1186/s12947-015-0040-5

 received in 2015-08-26, accepted in 2015-12-02,  发布年份 2015

来源: Springer

【 摘 要 】

BackgroundPrevious 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.MethodsIn 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.ResultsMild-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).ConclusionsTAVI 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.

【 授权许可】

CC BY   
© Costantino et al. 2015