Changes in Mitral Regurgitation Severity Post Transcatheter Aortic Valve Replacement in Severe Bicuspid Aortic Stenosis
Presenter
Kris Kumar, DO, MSc, The University of California, San Diego, Portland, OR
Kris Kumar, DO, MSc1, Timothy F Simpson, MD, Pharm.D2, Reyhaneh Akhavein, MD3, Howard K. Song, MD PhD3, Scott M Chadderdon, MD3, Harsh Golwala, MD4 and Firas E. Zahr, MD, FSCAI5, (1)The University of California, San Diego, Portland, OR, (2)Legacy Health, Portland, OR, (3)Oregon Health & Science University, Portland, OR, (4)-, Portland, OR, (5)OHSU Knight Cardiovascular Institute, Portland, OR
Keywords: Adult Congenital Heart Disease (ACHD), Structural Heart Disease (SHD) and TAVI/TAVR/Aortic Valve
Background
Severity of mitral regurgitation (MR) is known to improve in the majority of subjects with trileaflet aortic stenosis (AS) following transcatheter aortic valve replacement (TAVR), however there is no data regarding changes in MR following TAVR in patients with bicuspid AS.
Methods
Patients with severe bicuspid AS and underwent TAVR at a single center from 1/1/2013 to 12/31/2019 were analyzed. Baseline and 30-day follow-up echocardiograms were completed, and severity of MR was classified as mild, moderate, or severe. Primary outcome was proportion of patients with improvement of moderate or severe MR. Secondary outcome was proportion of net reclassification of any severity.
Results
49 patients with severe bicuspid AS undergoing TAVR were screened, with 30 meeting inclusion criteria (Figure 1). The cohort was an average of 71.4 years of age and 68% female, with 23% Sievers Type 0 and 77% Sievers Type 1. There was no association between degree of improvement in mean aortic valve gradient and improvement of MR (p = 0.77). The mean peak left ventricular pressure decreased by 30% following TAVR in all subjects, from mean 210 mmHg to 146 mmHg. Univariate linear analysis showed improvement in MR was independent of age (p=0.23), gender (p=0.56), Sievers type (p=0.83), baseline peak LV pressure (p=0.89), and systolic blood pressure (p=0.09).
Conclusions
TAVR in severe bicuspid AS was associated with significant improvement in concomitant MR and peak LV pressure. The effect was more pronounced with severe disease, independent of the hemodynamic improvement in mean gradient across the aortic valve.
