Clin Res Cardiol (2023). https://doi.org/10.1007/s00392-023-02180-w

Impact of transcatheter aortic valve implantation for aortic regurgitation on concomitant mitral and tricuspid regurgitation severity – a multicenter experience

H. S. Wienemann1, A. R. Tamm2, M. Geyer2, A. Goncharov3, V. Mauri1, S. Bleiziffer4, E. Kuhn5, S. Baldus6, T. K. Rudolph3, M. Adam1

1Klinik III für Innere Medizin, Herzzentrum der Universität zu Köln, Köln; 2Kardiologie 1, Zentrum für Kardiologie, Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Mainz; 3Allgemeine und Interventionelle Kardiologie/Angiologie, Herz- und Diabeteszentrum NRW, Bad Oeynhausen; 4Klinik für Thorax- und Kardiovaskularchirurgie, Herz- und Diabeteszentrum NRW, Bad Oeynhausen; 5Klinik für Herzchirurgie, herzchirurgische Intensivmedizin und Thoraxchirurgie, Universitätsklinikum Köln, Köln; 6Klinik für Kardiologie, Angiologie, Pneumologie und Internistische Intensivmedizin, Herzzentrum der Universität zu Köln, Köln;

Background: Transcatheter aortic valve implantation (TAVI) emerges as a promising interventional treatment method for severe aortic regurgitation (AR) in selected high-risk patients. Concomitant relevant mitral regurgitation (MR) or tricuspid regurgitation (TR) is frequently present in patients being evaluated for surgical aortic valve replacement. In contrast to surgery, MR and TR is usually left untreated at the time of TAVI. This study sought to analyze changes in MR and TR severity in patients undergoing TAVI for AR. Methods: This observational study included patients from 3 high volume sites across Germany. A total of 73 patients with severe aortic regurgitation (AR) underwent TAVI with either the JenaValve [JenaValve Technology, Irvine, CA] (n=59), Evolut R [Medtronic, Minneapolis, MI] (n=9) or Sapien 3 [Edwards Lifesciences, Irvine, CA] (n=5) by a transfemoral approach. Of these valve devices, only JenaValve has a CE mark approval for the treatment of AR. The severity of MR and TR was assessed by using a 6-class grading scheme: “none or trace”, “mild”, “mild-moderate”, “moderate”, “moderate-severe”, and “severe”. Results: Overall, the mean age was 77±9 years, and 43 % of patients were female. Mean transvalvular aortic pressure gradient was 8.6±5.7 mmHg and left ventricular function was impaired (LVEF <50%) in 54% of patients. Moderate/severe MR was present in 20 patients (27%) (Figure 1A) and moderate/severe TR (Figure 1B) was present in 15 patients (20.9%) before TAVI. After TAVI, AR was classified as mild in 9 (13%) patients and none/trace absent in all other patients. Mean transvalvular aortic pressure gradient was 4.9±2.3 mmHg. Presence of moderate/severe MR was 9.6% and moderate/severe TR 8.4% of the available echocardiograms at discharge. Conclusion: In this multicenter center of three current transcatheter aortic valves systems, TAVI in patients with AR was associated with a reduction of moderate/severe MR and TR at discharge. Figure 1. Incidence of mitral (A) and tricuspid (B) regurgitation before and after transcatheter aortic valve implantation for aortic regurgitation

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