October 30, 2019
Study Evaluates Outcomes of TAVR in Mixed Aortic Valve Disease
October 31, 2019—Findings from a study of the outcomes of transcatheter aortic valve replacement (TAVR) in mixed aortic valve disease (MAVD) were published by Johnny Chahine, MD, et al in Journal of the American College of Cardiology (JACC): Cardiovascular Interventions.
According to the investigators, the aim of the study was to compare outcomes after TAVR in patients with pure aortic stenosis (AS) (ie, no or trivial associated aortic regurgitation [AR]) with outcomes in patients with AS and mild or more severe AR (ie, MAVD).
As summarized in JACC: Cardiovascular Interventions, the study was composed of 1,133 patients who underwent TAVR between January 2014 and December 2017. The primary outcome was all-cause mortality. The comparison was adjusted to account for post-TAVR AR development in both groups. The secondary outcomes included composite endpoints of early safety and clinical efficacy as specified in the Valve Academic Research Consortium-2 criteria. Variables were compared using Mann-Whitney, chi-square, and Fisher exact tests. Kaplan-Meier analyses were used to compare survival.
The investigators reported that 688 patients (61%) had MAVD (median age, 83 years; 43% women). Among these, 17% developed mild, 2% moderate, and < 1% severe post-TAVR AR.
Overall, patients with MAVD had better survival compared with patients with pure AS (P = .03). Among patients who developed post-TAVR AR, those in the MAVD group had better survival (P = .04). In contrast, in patients who did not develop post-TAVR AR, pre-TAVR AR did not improve survival (P = .11).
The study showed that patients with MAVD who underwent TAVR had better survival compared with patients with pure AS. This is explained by the better survival of patients with MAVD who developed post-TAVR AR, likely due to left ventricular adaptation to AR, concluded the investigators in JACC: Cardiovascular Interventions.