Mixed aortic valve disease: Association with paravalvular leak and reduced survival after TAVR.

BACKGROUND: Transcatheter aortic valve replacement (TAVR) revolutionized the therapy of severe aortic stenosis (AS) with rising numbers. Mixed aortic valve disease (MAVD) treated by TAVR is gaining more interest, as those patients represent a more complex cohort as compared to isolated AS. However, concerning long-term outcome for this cohort only limited data is available.

AIMS: To assess the prevalence of MAVD in TAVR patients, investigate its association with paravalvular regurgitation (PVR), and analyse its impact on long-term mortality after TAVR.

METHODS: We conducted a registry-based cohort study using the Vienna TAVR registry, enrolling patients who underwent TAVR at Medical University of Vienna between 01/2007 and 05/2020 with available TTE before and after TAVR (n=880). Data analysis included PVR incidence and long-term survival outcomes.

RESULTS: 647 (73.52%) out of 880 patients had > mild AR next to severe AS. MAVD was associated with PVR compared to isolated AS with an OR of 2.06, 95% CI: 1.51- 2.81; p= <0.001. More than mild PVR after TAVR, (n168 out of 880 = 19.09%) was related to higher mortality compared to absence of PVR with a HR of 1.33, 95% CI: 1.05- 1.67; p= 0.016. MAVD patients developing ≥ mild PVR after TAVR was also associated with higher mortality compared to absence of PVR with HR of 1.30 and 95% CI: 1.04-1.62; p= 0.022.

CONCLUSIONS AND RELEVANCE: MAVD is prevalent among TAVR patients and presents unique challenges, with increased PVR risk and worse outcomes compared to isolated AS. Long-term survival for MAVD patients, not limited to those developing PVR post TAVR is compromised. Earlier intervention before the occurrence of structural myocardial damage or surgical valve replacement might be a potential workaround to improve outcomes.