The potential benefit of a staged edge-to-edge valvular intervention for mixed valvular heart disease (VHD) could improve outcomes in patients with persistent severe VHD post-transcatheter aortic valve replacement (TAVR). The multicenter study suggested this intervention was effective in the presence of severe concomitant VHD, a condition researchers linked with an increased 1- and 5-year mortality in patients with aortic stenosis (AS) undergoing TAVR. In this context, said the German-based research team, severe tricuspid regurgitation (TR) appeared to be associated with a higher mortality compared to severe MR. Study results The study findings were the focus of a presentation during Monday’s Late Breaking Clinical Science – Structural/LAA session as part of Cardiovascular Research Technologies (CRT) 2024 in Washington, D.C. Presented by Baravan Al-Kassou, MD, an interventional cardiologist at University Hospital Bonn in Germany, the study on 2,934 patients undergoing TAVR revealed that concomitant severe VHD was observed in 357 (12.2%) of these patients. Out of this population, 168 (5.7%) had a severe TR and 189 (6.5%) had a severe mitral regurgitation (MR) with moderate VHD seen in 876 (29.9%) patients. An additional staged edge-to-edge valvular intervention was performed on 59 (2.0%) patients due to severe TR and 147 (5.0%) patients due to severe MR. Along with colleagues from University Hospital Düsseldorf in Germany, researchers calculated the overall 1-year mortality rate to be 8.9% and 5-year all-cause mortality rate to be 23.3% following TAVR. The study’s authors pointed out that the 1-year all-cause mortality was higher in patients with a concomitant severe VHD (14.8%) as compared to patients with mild/no VHD (6.5%; p<0.01). Notably, the highest 1-year mortality was observed in patients with a concomitant severe TR (17.2%), followed by patients with a severe MR (12.7%) and mild/no VHD (6.5%; p<0.01). This difference persisted for up to 5 years after TAVR (p<0.01). Further analysis revealed that an additional staged edge-to-edge valvular intervention was associated with decreased 1-year mortality rate as compared to patients with persistent severe VHD (8.25% vs 14.8%, p<0.01). Multivariate regression analyses “This association remained over the five-year follow-up period (p<0.01) with multivariate regression analyses revealing that a concomitant severe TR (odds ratio [OR]:1.54; [95% confidence interval [CI]: 1.10-2.25; p=0.02) was independently associated with the mortality following TAVR,” added the study’s authors. Previous studies have reported increased short-term mortality rates in TAVR patients with concomitant moderate to severe MR and TR. However, the long-term impact of VHD on outcomes in patients undergoing TAVR is unknown. The research team highlighted that existing studies investigating additional VHD tended to focus on either concomitant MR or TR, lacking head-to-head comparisons of different VHD. “Although transcatheter edge-to-edge repair (TEER) for severe MR and TR has shown promising results, it remains unclear whether staged TEER for concomitant VHD improves outcomes in patients with AS undergoing TAVR,” the researchers said. Methodology The study cohort comprised 2,934 patients undergoing TAVR at the Heart Center Bonn, and the data were used to determine the prevalence of multiple VHD in a contemporary TAVR population. In addition, data from the patient group was also used to investigate and compare the impact of severe MR and TR on outcomes following TAVR. Results from this cohort were combined with TAVR cohorts from the Heart Centers in Düsseldorf, Dortmund, and Leipzig, who were all screened for additional staged valvular intervention. Patients who underwent staged TEER for severe MR or TR were also included. The primary endpoints included 1- and 5-year all-cause mortality following TAVR. Secondary endpoints comprised Valve Academic Research Consortium-3-defined complications at 30 days. Photo Credit: Bailey Salimes/CRTonline.org Photo Caption: Baravan Al-Kassou, MD, presents findings from a study on treating multiple valvular diseases concomitantly Monday at CRT 2024 in Washington, D.C.