Evolution and long-term impact of concomitant valvulopathies in patients undergoing transcatheter aortic valve implantation

Background: Multiple valvular heart disease (M-VHD) is a common condition, often involving aortic stenosis (AS) plus a mitral or tricuspid valve disease. We aim to evaluate the evolution and prognostic impact of M-VHD in patients undergoing transcatheter aortic valve implantation (TAVI). Methods: A retrospective cohort study was conducted on patients who underwent TAVI in a tertiary care center between January 2016 and December 2022. Echocardiography was performed before and after TAVI. The primary endpoint was the composite of all-cause mortality and cardiovascular hospitalizations during follow-up. Results: A total of 159 patients (88 women; mean [SD] age, 80.8 [7.8] years) with severe AS and M-VHD were identified. Seventy-two (45.3%) had mitral regurgitation, 69 (43.4%) had tricuspid regurgitation, and 18 (11.3%) had mitral stenosis. After TAVI, 77 patients (48.4%) experienced an improvement of the concomitant valve disease, while 82 did not. Female gender (OR:0.25, 95%CI:0.11-0.56, P<0.001), pacemaker implantation (OR:0.37, 95%CI:0.14-0.98, P=0.046) and rheumatic etiology (OR:0.25, 95%CI:0.09-0.74, P=0.012) were negatively associated with improvement. At a median follow-up of 31 months (26-51), patients with no improvement had an increased occurrence of the composite endpoint compared to their counterparties, (P=0.028). On multivariable analysis, NYHA class III/IV (HR:2.04, 95%CI:1.02-4.08, P=0.044) and creatinine (HR:1.43, 95%CI:1.06-1.94, P=0.019) were associated with a higher risk of the endpoint, while the improvement of concomitant valve disease emerged as protective factor (HR:0.46, 95%CI:0.25-0.85, P=0.013). Conclusions: Concomitant valve disease improved in roughly half of M-VHD patients after TAVI. Patients with post-TAVI improvement of the second valve lesion had better clinical outcomes at long-term follow-up.