Effectiveness and feasibility of transcatheter aortic valve replacement in treating combined aortic and mitral regurgitation: a retrospective observational study

BACKGROUND: Transcatheter aortic valve replacement (TAVR) is emerging as a less invasive procedure for aortic valve replacement. However, its effectiveness and feasibility in treating combined valvular disease remain controversial. In this study, we explored the clinical effectiveness and safety of TAVR in the treatment of combined aortic and mitral regurgitation. METHODS: The basic clinical characteristics and 1-month follow-up of 11 patients with combined aortic and mitral regurgitation who were treated with TAVR at center of structural heart disease, Zhongnan Hospital of Wuhan University from December 2021 to November 2022 were retrospectively analyzed. Echocardiographic parameters of aortic and mitral valve, complications, and all-cause mortality were compared pre- and post-TAVR. RESULTS: Retrievable self-expanding valve protheses were used in all patients, and the protheses were implanted via the transfemoral route in 8 patients and via the transapical route in 3 patients. There were 9 male and 2 female patients with an average age of 74.7±2.7 years. The mean Society of Thoracic Surgeons score was 8.5±1.2. Among the patients, 1 required retroperitoneal sarcoma semi-elective surgery, and 3 of the 5 patients with atrial fibrillation had their rhythm converted to sinus rhythm after operation. No perioperative deaths were recorded. Two patients underwent permanent pacemaker implantations due to high-grade atrioventricular blocks after TAVR. Moderate/severe mitral regurgitation (MR) were mostly secondary to aortic regurgitation (AR) as no rupture of the subvalvular tendon cords or rheumatic changes being recognized during echocardiography before operation. The mean left ventricular end-diastolic diameter (65.5±10.7 vs. 58.6±8.8 mm, P<0.001) and mitral annular diameter (36.7±5.4 vs. 31.5±2.8 mm, P<0.001) was significantly reduced after operation. MR was improved as the ratio of the regurgitant jet area to the left atrial area decreased significantly after operation (24.7%±11.5% vs. 42.4%±6.8% before operation, P<0.001). During the 1-month follow-up, the mean left ventricular ejection fraction was significantly improved (50.0%±9.4% vs. 44.6%±9.3% at admission, P=0.022). CONCLUSIONS: TAVR is effective and feasible for high-risk patients with combined aortic and mitral regurgitation.