The predictive value of a modified Carpentier classification in patients with coincidental mitral regurgitation undergoing TAVI for severe aortic valve stenosis¹

Article type: Research Article

Authors: Al-Hindwan, Haitham Saleh Ali^{a; 2} | Landmesser, Ulf^{a; 2} | Stähli, Barbara^a | Alushi, Brunhilda^a | Curio, Jonathan^a | Neumann, Tim^b | Jung, Friedrich^c | Lendlein, Andreas^c | Jacobs, Stephan^b | Reinthaler, Markus^{a; c; *}

Affiliations: [a] Department of Cardiology, Charité Universitätsmedizin Berlin, Campus Benjamin Franklin, Germany | [b] Department of Cardiac Surgery, German Heart Center Berlin, Germany | [c] Institute of Biomaterial Science and Berlin-Brandenburg Centre for Regenerative Therapies, Helmholtz-Zentrum Geesthacht, Germany

Correspondence: [*] Corresponding author: M. Reinthaler, Institute of Biomaterial Science and Berlin-Brandenburg Centre for Regenerative Therapies, Helmholtz-Zentrum Geesthacht, Kantstrasse 55, 14513 Teltow, Germany. Tel.: +49 0 3328 352 0; E-mail: markus.reinthaler@hzg.de.

Note: [1] This manuscript is dedicated to Prof. Friedrich Jung on the occasion of his 70th birthday.

Note: [2] These authors are equally contributed to this work.

Abstract: INTRODUCTION:Concomitant mitral-regurgitation (MR) is frequently observed in patients undergoing trans-catheter aortic valve implantation (TAVI). The predictive value of MR etiology remains to be elucidated. METHODS:600 patients with coincidental MR (≥moderate) undergoing TAVI were categorized according to a modified Carpentier classification [Groups: no/mild MR, n = 477; left atrial (LA) functional MR, n = 18; MR due to left ventricular dilatation, n = 29; degenerative MR, n = 50; MR with restricted leaflet motion n = 26]. MR improvement and patient outcome was compared among the groups in a retrospective analysis. RESULTS:MR regression was most pronounced in patients with restricted leaflet motion after 6 months, although a significant improvement was observed in all subgroups. MR relief was predominantly observed within the first 30 days after TAVI. Only patients with restricted leaflet motion experienced further improvement thereafter.In the entire cohort a total of 15 strokes (2.5%) during the first 30 days after TAVI were observed, with the highest incidence in the LA functional cohort (3 events, 17%; p = 0.008). In multivariate analysis, organic etiology was associated with an increased 1-year mortality.In conclusion, despite significant MR regression in all MR groups, some individuals may require additional mitralvalve repair after TAVI. According to our data the timing of these procedures should be based on the underlying MR etiology. The Carpentier classification in patients with coincidental MR undergoing TAVI for severe AS may also have prognostic implications as we found an increased incidence of strokes in our LA functional cohort and a worse mortality rates in organic MR.

Keywords: Trans-catheter aortic valve implantation, TAVI, Carpentier classification, LA functional MR, functional mitral regurgitation, organic mitral regurgitation

DOI: 10.3233/CH-189906

Journal: Clinical Hemorheology and Microcirculation, vol. 70, no. 1, pp. 15-25, 2018