The Fate of Mitral Valve Regurgitation after TAVI

All articles of this category (opens in new window) Background: There is sparse data on clinical outcomes of patients undergoing TAVI for severe aortic valve stenosis presenting with concomitant high-grade mitral regurgitation (MR). We sought to characterize the course of MR after TAVI by quantifying MR grade change over time and by comparing trajectories by etiology and severity. We hypothesized that TAVI leads to sustained reduction of MR, that lower residual MR confers superior survival, and that these associations differ by MR etiology. Methods: Retrospective analysis of patients undergoing TAVI from the institutional database between 2007 and 2023. Only patients with MR grade classified as moderate-severe or severe were included. The primary endpoint was defined as MR grade change between pre-TAVI, discharge, and last follow-up (>1 year post-TAVI), obtained through serial studies up to ≥ 5 years. The clinical endpoint was all-cause mortality. Secondary analyses assessed outcomes by etiology, discharge MR grade, and MR improvement. Results: Of 4,584 consecutive TAVR patients with severe aortic stenosis, 112 with more than moderate baseline MR were included. Baseline characteristics: age mea n = 82 years, 49 male vs. 63 female, Euroscore II mea n = 7, LVEF mea n = 49%, 94 functional vs. 18 degenerative. During follow-up, eight patients received further treatment (mTEER = 6, TMVI = 2). At discharge, 34% of patients demonstrated improvement of MR > one grade, 26% had improved one MR grade, while 40% of patients showed no improvement. From pre-TAVI to FU, 62% of patients had improved > one grade, 24% one MR grade, and 14% showed no further improvement. Five-year survival analyses based on etiology (functional vs. degenerative), discharge MR grade (mild n = 15, moderate n = 39, severe n = 53), or MR grade improvement (improvement vs. no improvement) showed no difference between groups ( p = 0.23; p = 0.21; p = 0.35). Conclusion: In patients with severe aortic stenosis and concomitant high-grade MR, TAVI was associated with sustained MR downgrading from discharge to ≥ 1-year follow-up. Against expectations, survival was unaffected by lower MR grade, early MR improvement, or functional etiology. These findings may support a surveillance-first strategy after TAVI. Intervention decisions should be individualized for persistent high-grade or symptomatic MR within a multidisciplinary team, with modest expectations regarding prognostic benefit. Publication History Article published online: 17 February 2026 © 2026. Thieme. All rights reserved. Georg Thieme Verlag KG Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany