Impact of Concomitant Mitral Regurgitationon Outcomes after Transcatheter Aortic Valve Implantation for Aortic Stenosis: A Systematic Review and Meta-Analysis
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Abstract
Introduction: Moderate-to-significant mitral regurgitation (MR) is frequently observed in patients with severe
symptomatic aortic stenosis who undergo transcatheter aortic valve replacement (TAVR). However, its prognostic
significance remains uncertain, as earlier trials often excluded MR, and contemporary guidelines are conflicting.
This meta-analysis quantified the impact of preprocedural MR on mortality, stroke, bleeding, and rehospitalization
after TAVR and explored whether age, sex, or left ventricular ejection fraction (LVEF) modified the mortality risk.
Materials and Methods: PubMed and Cochrane Library were searched until October 15, 2023, according to the
Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. English-language studies comparing
TAVR outcomes in patients with and without MR were included in this review. The risk of bias was assessed using
the Newcastle-Ottawa and RoB 2.0 tools. Pooled effects were estimated using Mantel-Haenszel random-effects
models, with subgrouping, sensitivity analyses, and meta-regression for age, male gender, and LVEF. Results:
Twenty-four studies (n = 23,796; mean age = 81.8; 45.6% male) met the criteria, with no evident publication bias and
high methodological quality. Baseline MR was associated with higher all-cause mortality at 30 days (relative risk [RR]:
1.68, 95% confidence interval [CI]: 1.31–2.15), 6 months (RR: 1.94, 95% CI: 1.30–2.90), 1 year (RR: 1.75, 95% CI:
1.38–2.22), and 2 years (RR: 95% CI: 1.30, 1.08–1.56); the excess risk was consistent in observational studies, while RCT
subgroup estimates were neutral at longer follow-up. MR was not associated with stroke (RR: 0.83, 95% CI: 0.67–1.04)
or bleeding (RR: 0.95, 0.88–1.04) but was linked to increased rehospitalization (RR: 1.79, 1.06–3.04). Meta-regression
analysis showed no correlation between mortality and
age, sex, or LVEF. Conclusion: Concomitant MR
identifies a high-risk TAVR population warranting
enhanced assessment and follow-up. Future work
should stratify by MR severity and etiology and
evaluate post-TAVR MR evolution to refine
patient selection and mitral intervention strategies.
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