IMPACT OF CALCIFIC MITRAL STENOSIS ON SURVIVAL IN PATIENTS UNDERGOING TRANSCATHETER AORTIC VALVE REPLACEMENT

Objectives. This study was performed to investigate the prevalence and impact on survival of baseline calcific mitral stenosis (MS) in patients undergoing transcatheter aortic valve replacement (TAVR) due to the presence of severe symptomatic aortic stenosis (AS). Methods. This retrospective study included 928 consecutive patients with severe, symptomatic AS undergoing TAVR in two institutions, from January 2012 to August 2016. Mean follow-up was 40.8±13.9 months. Results. Based on mean mitral gradients (MMG) at baseline, 3 groups were identified: normal-mild, MMG<5 mmHg (n=737, 81.7%); moderate MMG5 and <10 mmHg (n=147, 16.3%); severe MMG10 mmHg (n=17, 1.9%). These latter were more frequently women, with a smaller body surface area, a higher prevalence of atrial fibrillation, chronic obstructive pulmonary disease and previous history of CABG/PCI. At baseline, patients with MMG10 mmHg compared with 5 and <10 mmHg and normal patients exhibited a lower mitral valve area (2.4±0.94 vs 2.1±0.86 vs 1.5±0.44 cm2) a lower prevalence of MR2+ (5.9% vs 28.6% and 15.6%, p<0.0001), a higher prevalence of severe mitral annular calcium (70.6% vs 45.6% and 13.0%, p<0.0001) and a higher systolic pulmonary arterial pressure (50.6±12.1 vs 47.2±14.5 and 41.6±14.4, p<0.0001). Despite the low prevalence of MMG10 mmHg, these patients experienced higher 5-year mortality compared to the other groups (adjusted Hazard Ratio: 2.91, 95% Confidence Interval [CI]:1.17-7.20, p=0.02). Conclusions. Severe calcific MS is uncommon in patients undergoing TAVR. However, its presence is associated with higher long-term mortality whereas moderate MS is not. The presence of severe calcific MS might identify a subgroup of patients in whom a double valve intervention should be considered.