Improved mitral valve performance after transapical aortic valve implantation.

Abstract

Concomitant mitral regurgitation (MR) is frequently present before the performance of transapical aortic valve implantation (TA-AVI). Our aim was to study the impact of MR on outcome and the effect of TA-AVI on MR using the Edwards SAPIEN prosthesis (Edwards Lifesciences, Irvine, CA). A total of 439 patients aged 81.5±6.4 years, 64.0% of whom were women, underwent TA-AVI between February 2006 and August 2011. The mean logistic EuroSCORE was 29.7%±15.7% and the mean Society of Thoracic Surgeons (STS) score was 11.4%±7.6%. Outcome was assessed in patients with absent (9.8%), mild or trivial (58.5%), moderate (29.7%), and severe (2.0%) MR by pre- and postoperative echocardiography. Patients with moderate/severe MR versus mild or trivial MR had an increased in-hospital mortality (adjusted hazard ratio [HR], 3.98; 95% confidence interval [CI], 1.79-8.84; p=0.001) but a comparable 4-year survival (adjusted HR, 1.29; 95% CI, 0.47-3.49; p=0.623). During postoperative echocardiographic examination, there was an overall improvement in mitral incompetence (absent in 23.6%, mild in 58.6%, moderate in 17.8%, and severe in none). Independent multivariate variables associated with improved MR were MR greater than 1+ (odds ratio [OR], 7.73; p<0.001), the presence of functional MR (OR, 3.66; p=0.011), left ventricular ejection fraction (LVEF) of 60% or more (OR, 3.28; p=0.002), and a mean transaortic gradient (OR, 1.03; p=0.005). Moderate/severe MR before TA-AVI is associated with an increased early, but a comparable late, mortality. We observed an overall improved mitral valve performance, possibly resulting from reducing both subvalvular traction and closure forces acting on the mitral valve.