Association of mitral valve geometry at CT with secondary mitral regurgitation after transcatheter aortic valve replacement in patients with aortic regurgitation

Abstract Purpose To determine predictors of persistent moderate to severe secondary mitral regurgitation in patients with aortic regurgitation after transcatheter aortic valve replacement (TAVR) by mitral valve geometry assessment at CT. Methods This retrospective cohort study reviewed 242 consecutive patients with aortic regurgitation who underwent TAVR between May 2014 and February 2023. Patients with primary or less than moderate mitral regurgitation were excluded. Mitral annular dimensions (area, perimeter, anteroposterior, intercommissural, and trigone-to-trigone diameter), mitral valve tenting geometry (tenting area and tenting height), and papillary muscle displacement were systematically measured at CT. Mitral regurgitation improvement was assessed at 1 month after TAVR by echocardiography. Logistic regression was performed to explore the association of mitral valve geometry with mitral regurgitation improvement after TAVR. Results A total of 75 patients (mean age, 74 ± 7 years; 32.0% female) with moderate to severe secondary mitral regurgitation were included in the final analysis. Mitral regurgitation improved in 49 patients and remained unchanged in 26 patients. Mitral annular dimensions, including area, perimeter, anteroposterior, and intercommissural diameter, were associated with mitral regurgitation improvement. Mitral valve tenting area (MVTA) and tenting height were risk factors for sustained mitral regurgitation. In addition, QRS duration > 120ms and atrial fibrillation had an impact on the mitral regurgitation improvement. Mitral annular area (OR, 1.41; 95%CI: 1.05, 1.90; p = 0.02) and MVTA (OR, 7.24; 95%CI: 1.72, 30.44; p = 0.007) were independent predictors of persistent secondary mitral regurgitation after TAVR. Conclusions Mitral annular area and MVTA were independent predictors of persistent secondary mitral regurgitation after TAVR.