Outcomes after Transcatheter and Surgical Aortic Valve Replacement in Intermediate Risk Patients with Preoperative Mitral Regurgitation: Analysis of PARTNER II Randomized Cohort

ABSTRACT

Background: Preoperative mitral regurgitation (MR) in patients undergoing transcatheter (TAVR) and surgical aortic valve replacement (SAVR) has been studied in high-risk cohorts. This study examines the outcomes of preoperative MR (≥ moderate) in a larger, intermediate-risk cohort.

Methods: The Placement of Aortic Transcatheter Valves (PARTNER) 2A Trial randomized 2032 intermediate-risk patients with severe, symptomatic aortic stenosis to TAVR or SAVR. An ad-hoc analysis was performed on 1738 patients with baseline MR echocardiographic data. Patients were analyzed according to the degree of preoperative MR (≥ moderate versus ≤ mild).

Results: At baseline, ≥ moderate MR was reported in 300 patients (17%). At 30 days, ≥ moderate MR had improved in 47% to ≤ mild. Thirty-day mortality was higher in SAVR patients with ≥ moderate MR (8.0 versus 3.5%; p = 0.01), but this difference was not seen in TAVR (2.7 vs. 3.1%; p = 0.78). At 2-years, the combined outcome of death (20.5 vs. 16.3%; p = 0.07), stroke (12.9 vs. 9.0%; p = 0.06), and rehospitalization (22.0 versus 17.4%; p = 0.06) was higher in the ≥ moderate MR (40.4 vs. 32.6%; p = 0.009), and similar between SAVR and TAVR (39.8 vs. 41.0%; p = 0.89).

Conclusions: Significant MR is prevalent in patients with severe AS and affects clinical outcomes after both TAVR and SAVR. SAVR patients with MR have high early risk, but the increased risk of death/stroke/rehospitalization becomes similar in both groups over time. Improvement in MR is common, especially in patients with lower ejection fraction and larger left-ventricular dimensions.

KEYWORDS:

• Aortic stenosis
• mitral regurgitation
• surgical aortic valve replacement
• transcatheter aortic valve replacement

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Acknowledgments

The authors would like to thank Maria Alu, MS (Columbia University Medical Center) for assistance with manuscript preparation.

Disclosure statements

Dr. Malaisrie is a consultant for Edwards Lifesciences, Medtronic and a speaker for Abbott Vascular. Dr. McAndrew has nothing to disclose. Dr. Swanson has nothing to disclose. Dr. Hahn has Core Lab contracts with Edwards Lifesciences for which she receives no direct compensation and is a consultant for Philips Healthcare, St. Jude Medical, and Boston Scientific. Dr. Pibarot holds the Canada research Chair in Valvular Heart Diseases, Canadian Institutes of Health Research, Ottawa, Ontario, Canada, has Core Lab contracts with Edwards Lifesciences for which he receives no direct compensation, and is a consultant for St Jude Medical. Dr. Jaber has Core Lab contracts with Edwards Lifesciences for which he receives no direct compensation. Dr. Quader has nothing to disclose. Dr. Zajarias is a consultant for Edwards Lifesciences. Dr. Svensson holds equity in Cardiosolution and Valvexchange; intellectual property with Postthorax; and is a member of the PARTNER Trial Executive Committee for which he receives no direct compensation. Dr. George is a consultant for Edwards Lifesciences and Medtronic. Dr. Thourani is a consultant for Edwards Lifesciences, Abbott, Sorin Medical, St. Jude Medical, and DirectFlow. Dr. Szeto is a consultant for Microinterventional Devices. Drs. Smith, Leon, and Webb are members of the PARTNER Trial Executive Committee for which they receive no direct compensation.

Supplementary material

Supplemental data for this article can be accessed on the publisher’s website.

Additional information

Funding

The PARTNER II Trial was funded by Edwards Lifesciences.