Patients with severe mitral stenosis (MS) undergoing TAVR may have an increased risk of adverse outcomes, including mortality after one year, when compared with patients who do not have MS or whose MS is nonsevere, according to a study published April 2 in JACC: Cardiovascular Interventions.

Lee Joseph, MD, MS, et al., used the STS/ACC TVT Registry, along with claims data from the Centers for Medicare and Medicaid Services, to examine 44,755 patients ages 18 and older who underwent TAVR between November 2011 and September 2015. MS was present in 5,201 patients (11.6 percent), with severe MS occurring in 1,214 patients (2.7 percent) and nonsevere MS occurring in 3,987 patients (8.9 percent).

Results showed that the in-hospital mortality rate was 5.6 percent for patients with severe MS, compared with 4.1 percent and 3.9 percent, respectively, for patients with no MS and nonsevere MS. The three MS severity groups had similar rates of in-hospital mortality and stroke, myocardial infraction, and procedure-related death. After one year, 40.2 percent of patients with severe MS had experienced the primary composite outcome of mortality, stroke, heart failure-related hospitalization and mitral valve intervention, compared with 33.5 percent for patients without MS and 33.7 percent for patients with nonsevere MS. In addition, patients with severe MS had a higher risk of mortality and heart failure-related hospitalization after one year than patients without MS.

The researchers conclude that the “higher risk for adverse events must be carefully considered when evaluating patients with combined aortic and MS for TAVR.”

In an accompanying editorial, Magnus Settergren, MD, PhD, et al., write that the study “contributes important contemporary epidemiologic insights” to data on management of mixed and multiple valve diseases and “opens the field for further research and development of an evidence base in the transcatheter era.”

Keywords: STS/ACC TVT Registry, Registries, National Cardiovascular Data Registries, Hospital Mortality, Mitral Valve Stenosis, Mitral Valve, Transcatheter Aortic Valve Replacement, Centers for Medicare and Medicaid Services, U.S., Medicare, Medicaid, Heart Failure, Heart Valve Diseases, Stroke, Hospitalization

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