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Elsevier, American Journal of Cardiology, 6(114), p. 875-882

DOI: 10.1016/j.amjcard.2014.06.022

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Meta-Analysis of Mortality Outcomes and Mitral Regurgitation Evolution in 4,839 Patients Having Transcatheter Aortic Valve Implantation for Severe Aortic Stenosis

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This paper is available in a repository.

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Abstract

Transcatheter aortic valve implantation (TAVI) is an effective alternative therapy in selected patients with severe aortic stenosis. The role and effects of coexistent moderate to severe mitral regurgitation (msMR) in patients undergoing TAVI remain still unclear. Thirteen studies enrolling 4,839 patients undergoing TAVI, including patients with msMR, were considered in the meta-analysis and analyzed for all-cause-mortality; a further meta-analysis was performed to assess MR evolution post TAVI. In patients with msMR, all-cause-mortality post TAVI was significantly increased, at 30-day (ES: -0.18; 95% confidence interval CI: -0.31 to -0.04, I2 = 46.51, Q = 7.48), 1-year (ES: -0.22; 95% CI: -0.36 to -0.08, I2 = 56.20, Q = 11.41) and 2-year-follow-up (ES: -0.15; 95% CI: -0.27 to -0.02, I2 = 0.00, Q = 2.64) compared to patients with absent or mild MR, independently from baseline left ventricular ejection fraction. Interestingly, msMR impact on outcome was statistically stronger when the CoreValve System was used. TAVI was also associated with an improvement in MR entity at 3/6-month-follow-up (overall ES: -0.19, 95% CI: -0.37 to -0.01, I2 = 61.52, Q = 10.39). In conclusion, the presence of preoperative msMR in patients with severe, symptomatic aortic stenosis undergoing TAVI negatively impacts on outcome after TAVI. In addition, in the same setting of patients, a trend towards an improvement in MR severity is observed. Whether the recovery in MR severity impacts on mortality after TAVI remains to be defined.