TAvi after PrevIous Mitral Valve Repair or Replacement (TAPIR) Registry

Background: Patients with prior surgical mitral valve repair or replacement (SMVR) have been largely excluded from randomized trials comparing transcatheter aortic valve implantation (TAVI) and surgical aortic valve replacement. The anatomical proximity between the mitral and aortic annulus poses a risk for interference between the transcatheter device and existing mitral prosthesis or rings. The international TAPIR registry was created to assess TAVI outcomes in patients with prior SMVR and identify anatomical criteria for adverse outcomes.

Methods: Between 2010 and 2022, 365 patients who underwent TAVI following SMVR were enrolled from 16 European centers. VARC-3 outcomes were evaluated retrospectively at 30 days, with follow-up extending to 60 months post-TAVI. The TAPIR cohort was compared with a matched retrospective cohort of 4,832 patients who had not undergone prior mitral valve surgery from the UHC Hamburg. A total of 13 different variables were used for matching, resulting in two cohorts with 202 patients each.

Results: Group 1 represented the control group, while group 2 comprised the TAPIR cohort. Post-matching analysis showed no significant differences in baseline characteristics ([group 1 versus group 2] age: 79.0 [74.86, 82.83] versus 79.00 [74.00, 83.75] years, p = 0.97; male: 36.6% versus 40.1%, p = 0.54; LVEF: 55.00 [40.00, 61.00] versus 54.00 [40.00, 59.00] %, p = 0.1). The rate of transfemoral access was high in both groups (94.1% versus 91.6%, p = 0.44). Mean transvalvular gradients after TAVI were similar between groups (9.00 [5.00, 14.00] versus 8.00 [6.00, 11.00] mmHg, p = 0.28). There were no significant differences in device success (88.72% versus 88.61%, p = 1.0), myocardial infarction (2.0% versus 0%, p = 0.14), renal failure >AKIN II (1.52% versus 1.58%, p = 1), stroke (2.11% versus 0.64%, p = 0.49), permanent pacemaker implantation (6.09% versus 4.69%, p = 0.06), or moderate-to-severe paravalvular leakage (PVL) (4.17% versus 3%, p = 0.94). However, group 2 exhibited a significantly higher rate of mild PVL (23.44% versus 43.0%, p < 0.01). There was no significant difference in 5-year mortality (58.6% versus 54.4%, p = 0.32).

Conclusion: TAVR in patients with prior SMVR is safe and feasible, with no significant increase in 5-year mortality compared with those without prior mitral valve surgery. While there was a higher incidence of mild paravalvular regurgitation, this did not lead to worse clinical outcomes or increased reintervention rates.

NB: This abstract was presented in a similar form at a previous meeting.

Publication History

Article published online:
11 February 2025