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The Impact of Transcatheter Aortic Valve Replacement on Mitral Regurgitation and Pulmonary Hypertension

AUTHORS

avatar Azin Alizadehasl ORCID 1 , avatar Ata Firouzi ORCID 2 , avatar Zohre Rahbar ORCID 3 , * , avatar Zahra Hosseini ORCID 3 , avatar Vajiheh Dorosti ORCID 3 , avatar Yasaman Khalili ORCID 4 , avatar kamran roudini ORCID 5

1 Cardio Oncology Research Center, Rajaie Cardiovascular Medical and Research Center, Tehran, IR Iran

2 Department of Echocardiography, Rajaie Cardiovascular Medical and Research Center, Tehran, IR Iran

3 Department of Interventional Cardiology, Rajaie Cardiovascular Medical and Research Center, Tehran, IR Iran

4 Department of interventional cardiology, Rajaie Cardiovascular Medical and Research Center, Tehran, Iran

5 Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, IR Iran

How to Cite: Alizadehasl A, Firouzi A , Rahbar Z, Hosseini Z, Dorosti V, et al. The Impact of Transcatheter Aortic Valve Replacement on Mitral Regurgitation and Pulmonary Hypertension. Int Cardio Res J. 2022;16(1):e120429.

ARTICLE INFORMATION

International Cardiovascular Research Journal: 16 (1); e120429
Published Online: March 12, 2022
Article Type: Research Article
Received: July 09, 2021
Revised: December 16, 2022
Accepted: December 27, 2022
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Abstract

Background: The presence of concomitant Mitral Regurgitation (MR) and Pulmonary
Hypertension (PH) is a common issue in patients undergoing Transcatheter Aortic
Valve Replacement (TAVR). Transthoracic echocardiography plays a role in detecting
MR severity and PH before and after TAVR.
Objectives: This study aimed to investigate the impact of TAVR on MR severity and PH
and to detect the predictors of their improvement.
Methods: Totally, 111 patients underwent TAVR at Rajaee Heart Center, Tehran, Iran
from December 2012 to January 2021. In this retrospective study, these patients were
evaluated for MR and PH improvement after TAVR. The final analysis was performed
separately on 32 patients who had moderate or more severe baseline MR and 56 patients
with any grade of PH at baseline. Group comparisons based on the MR severity, PH
severity, and improvement of MR and PH were analyzed using student t-test for
continuous variables and chi-square or Fisher’s exact test for categorical ones. Finally,
the percentage of the patients with improved MR or PH as well as the factors associated
with the improvements were determined.
Results: Moderate or more severe baseline MR improved by at least one grade one
year post-TAVR in 56.2% of the cases, and TAVR with a balloon-expandable valve
was associated with a higher probability of MR improvement. Baseline left ventricular
ejection fraction was significantly lower in patients with a higher degree of PH than
in those with lower degrees (43% vs. 30%, P < 0.001). In addition, right ventricular
dysfunction was more prevalent in patients with a higher degree of PH. Post-TAVR
reduction in systolic pulmonary pressure (at least 10 mmHg) was observed in 77% of the
patients after one year.
Conclusions: TAVR positively affected MR and PH and reduced their severity in
most patients. Tricuspid native aortic valve (in comparison with bicuspid), normal
sinus rhythm (in comparison with atrial fibrillation), left ventricular ejection fraction
improvement, and absence of left atrial enlargement were associated with a greater MR
improvement after TAVR. Left ventricular ejection fraction improvement and TAVR
with a balloon-expandable valve were also significantly associated with PH improvement
post TAVR.

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References

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© 2022, Shiraz University of Medical Sciences.
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