After nearly two decades of application and development, the clinical efficacy of transcatheter aortic valve replacement (TAVR) has been continuously improved and demonstrated. Due to the expansion of indications of TAVR, the frequency of encountering patients with mixed valvular diseases increases greatly, particularly the moderate to severe mitral regurgitation combined with aortic stenosis. Multiple registry studies suggest that the incidence of significant mitral regurgitation is approximately 13% to 74% in patients who undergo TAVR. Some studies have reported that moderate to severe MR is associated with higher mortality, while simultaneous aortic and mitral valve surgery is associated with significantly higher surgical risk. Therefore, the optimal treatment strategy for this special patient group remains uncertain. With the further development of transcatheter therapy, staged surgery may be a feasible solution. However, there is currently a lack of evidence-based support such as randomized clinical trials. This review aims to report and evaluate relevant existing research data to help clinicians make optimal treatment decisions for this specific patient populations.
ObjectiveTo determine the clinical efficacy of transcatheter aortic valve replacement (TAVR) for severe aortic regurgitation (AR) combined with severe mitral regurgitation (MR). MethodsThe clinical data of 13 patients who underwent TAVR due to severe AR combined with severe MR from March 2018 to September 2021 in our hospital were retrospectively analyzed, including 10 males and 3 females with a mean age of 72.54±2.35 years. The echocardiographic findings of all patients were compared preoperatively and postoperatively. ResultsSurgeries were performed successfully in all patients without intraoperative death or conversion to sternotomy. The operation time was 118.15±11.42 min, intraoperative blood loss was 100.00 (75.00, 250.00) mL, and the length of hospital stay after surgery was 9.00 (4.50, 11.00) d. The mean follow-up duration was 10.00 (6.50, 38.50) months, during which there were 2 patients with mild to moderate AR, 6 with mild AR, and 5 with no AR; meanwhile, severe MR decreased significantly (P=0.001) even without active intervention, including 4 mild to moderate MR and 9 mild MR patients. Compared to preoperative indexes, the left atrial diameter [46.00 (41.00, 52.50) mm vs. 35.00 (34.00, 41.00) mm, P<0.001], left ventricular end-systolic diameter [45.00 (36.00, 56.00) mm vs. 35.00 (28.00, 39.00) mm, P=0.002] and left ventricular end-diastolic diameter (62.62±2.40 mm vs. 51.08±2.49 mm, P<0.001) showed a decreasing trend during the follow-up. ConclusionIn selected patients with severe AR combined with severe MR, TAVR alone improves AR and combined MR at the same time.