Can J Cardiol. 2025 Dec 31:S0828-282X(25)01614-9. doi: 10.1016/j.cjca.2025.12.046. Online ahead of print.
ABSTRACT
BACKGROUND: Multivalvular heart disease (MVHD) is frequently encountered in patients undergoing transcatheter aortic valve replacement (TAVR). However, the long-term prognostic impact of MVHD in this population remains poorly characterized. The aim of this study was to evaluate the long-term clinical outcomes and echocardiographic evolution of MVHD in TAVR recipients.
METHODS: A total of 1,918 consecutive patients with severe symptomatic aortic stenosis (AS) undergoing TAVR were included. MVHD was defined as the presence of moderate or greater mitral (MR) and/or tricuspid regurgitation (TR) prior to the procedure. Baseline, procedural, and follow-up data (median of 4.0 [2.8-5.2] years) were prospectively collected. Changes in MR and/or TR severity were assessed from baseline to the last available echocardiography RESULTS: A total of 450 (23.5%) patients had MVHD at baseline. The presence of MVHD was associated with an increased all-cause mortality (adjusted HR: 1.21, 95% CI: 1.04-1.40; p=0.011) and cardiovascular mortality (adjusted HR: 1.29, 95% CI: 1.04-1.61; p=0.018) at follow-up. After adjustment, only baseline moderate or greater TR remained independently associated with all-cause mortality (HR: 1.38; CI: 1.04-1.84; p=0.027). At discharge, MR improved in 181 patients (51.7%) with similar rates across MR mechanism (p = 0.582), while those with TR improved in 71 (40.5%). MVHD improvement was sustained over time, whereas the absence of recovery was associated with a higher risk of all-cause mortality and cardiovascular mortality up to 6 years.
CONCLUSIONS: Patients with MVHD exhibit worse long-term outcomes after TAVR. While TAVR provides sustained improvement of concomitant valvular lesions in about half of patients, lack of recovery at discharge, predicted poorer long-term survival, highlighting the need for comprehensive baseline assessment and close echocardiographic follow-up in this high-risk population.
PMID:41482148 | DOI:10.1016/j.cjca.2025.12.046