• Crochan J O'Sullivan, Stefan Stortecky, Anne Bütikofer, Dik Heg, Thomas Zanchin, Christoph Huber, Thomas Pilgrim, Fabien Praz, Lutz Buellesfeld, Ahmed A Khattab, Stefan Blöchlinger, Thierry Carrel, Bernhard Meier, Stephan Zbinden, Peter Wenaweser, and Stephan Windecker.
• From the Department of Cardiology (C.J.O., S.S., A.B., T.Z., T.P., F.P., L.B., A.A.K., S.B., B.M., S.Z., P.W., S.W.), Department of Cardiovascular Surgery (C.H., T.C.), and Clinical Trials Unit (D.H.), Bern University Hospital, Bern, Switzerland; and Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland (D.H.).
• Circ Cardiovasc Interv. 2015 Feb 1;8(2):e001895.

BackgroundUp to 1 in 6 patients undergoing transcatheter aortic valve implantation (TAVI) present with low-ejection fraction, low-gradient (LEF-LG) severe aortic stenosis and concomitant relevant mitral regurgitation (MR) is present in 30% to 55% of these patients. The effect of MR on clinical outcomes of LEF-LG patients undergoing TAVI is unknown.Methods And ResultsOf 606 consecutive patients undergoing TAVI, 113 (18.7%) patients with LEF-LG severe aortic stenosis (mean gradient ≤40 mm Hg, aortic valve area <1.0 cm(2), left ventricular ejection fraction <50%) were analyzed. LEF-LG patients were dichotomized into ≤mild MR (n=52) and ≥moderate MR (n=61). Primary end point was all-cause mortality at 1 year. No differences in mortality were observed at 30 days (P=0.76). At 1 year, LEF-LG patients with ≥moderate MR had an adjusted 3-fold higher rate of all-cause mortality (11.5% versus 38.1%; adjusted hazard ratio, 3.27 [95% confidence interval, 1.31-8.15]; P=0.011), as compared with LEF-LG patients with ≤mild MR. Mortality was mainly driven by cardiac death (adjusted hazard ratio, 4.62; P=0.005). As compared with LEF-LG patients with ≥moderate MR assigned to medical therapy, LEF-LG patients with ≥moderate MR undergoing TAVI had significantly lower all-cause mortality (hazard ratio, 0.38; 95% confidence interval, 0.019-0.75) at 1 year.ConclusionsModerate or severe MR is a strong independent predictor of late mortality in LEF-LG patients undergoing TAVI. However, LEF-LG patients assigned to medical therapy have a dismal prognosis independent of MR severity suggesting that TAVI should not be withheld from symptomatic patients with LEF-LG severe aortic stenosis even in the presence of moderate or severe MR.© 2015 American Heart Association, Inc.

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