Impact of Transcatheter Aortic Valve Replacement on the Mitral Valve Apparatus and Mitral Regurgitation: A Real-Time Three-Dimensional Transesophageal Echocardiography Study
Background—The impact of transcatheter aortic valve replacement (TAVR) on the mitral valve apparatus and factors influencing reduction of mitral regurgitation (MR) with or without mitral leaflet tethering after TAVR are poorly understood. The present three-dimensional transesophageal echocardiography (3DTEE) study aimed to further elucidate early changes in the structure and function of the mitral valve apparatus after TAVR.
Methods and Results—We analyzed 90 patients (Non-Tenting group: 56 patients and Tenting group: 34 patients) who underwent TAVR using the Edwards SAPIEN and had intra-procedural 3DTEE evaluation of the mitral valve. Of all patients, MR improved in 54%, remained the same in 38% and worsened in 8% one day after TAVR. There were no statistically significant differences in mitral annular three-dimensional parameters before and after TAVR in both groups. In the Tenting group, tenting area (p <0.01) and tenting height (p <0.01) were decreased and coaptation length was increased (p <0.05) after TAVR. In a multivariable analysis, the predictors of improved MR were the decrease of tenting area (Odds ratio: 8.15; 95% CI: 1.31-50.7; p <0.05) and the decrease of valvulo-arterial impedance (Zva) (Odds ratio: 7.57; 95% CI: 1.15-49.9; p <0.05) in the Tenting group, and the decrease of Zva (Odds ratio: 6.96; 95% CI: 1.24-39.2; p <0.05) in the Non-Tenting group.
Conclusions—Mitral leaflet tethering was improved immediately by TAVR in patients with mitral leaflet tenting regardless of mitral annular geometry. Acute improvement in MR after TAVR is predominantly related to global left ventricular hemodynamics and mitral leaflet tethering change.
- Received July 23, 2013.
- Accepted January 16, 2014.