Prognostic Implications of Degenerative Mitral Regurgitation on Eligibility for TAVI

Transcatheter aortic valve implantation (TAVI) has emerged as the primary treatment strategy for severe symptomatic aortic stenosis (AS) in the older population (>75 years of age) with high-risk surgical profiles. The growing older population and the concomitant age-related high prevalence of degenerative AS, combined with evidence of the non-inferiority of the TAVI procedure over surgical aortic valve replacement in intermediate-risk patients, increase the potential number of TAVI candidates. Concerns regarding the higher costs of TAVI than surgical aortic valve replacement are balanced by its shorter length of hospitalization and lower acute complication costs. However, the growing use of such treatment should lead to changes in the patient selection paradigm. Several studies have outlined the prognostic benefits of the procedure and identified independent negative factors. Among others, mitral regurgitation (MR) is frequently detected in patients diagnosed with AS. Improvements in MR after aortic valve stenosis surgical correction have been demonstrated. The pre-operative presence of degenerative MR can affect prognosis after TAVI and serves as independent factor in worsening overall cardiac function. Solely grading degenerative MR does not enable proper stratification of patients according to their heart function and may be the reason for the discordant results. This short communication discusses how TAVI candidates, affected by degenerative MR, can be correctly stratified to avoid poor postoperative prognosis.