Does pre-existing aortic regurgitation protect from death in patients who develop paravalvular leak after TAVI?

Int J Cardiol. 2017 Apr 15;233:52-60. doi: 10.1016/j.ijcard.2017.02.005. Epub 2017 Feb 4.

Abstract

Objective: The aim of this study was to investigate interactions among pre-procedural aortic regurgitation (AR), post-procedural paravalvular leak (PVL) and long-term clinical outcomes.

Methods and results: We analyzed data prospectively collected in the Italian Transcatheter balloon-Expandable Registry (ITER) on aortic stenosis (AS) patients. The degree of pre-procedural AR and post-procedural PVL was stratified as: absent/trivial, mild, and moderate/severe. VARC definitions were applied to outcomes. Of 1708 patients, preoperatively, AR was absent/trivial in 40% of the patients, mild in 42%, and moderate in 18%. Postoperatively, PVL was moderate-severe in 5%, mild in 32% of patients, and absent/trivial in 63%. Clinical follow-up, median 821days (IQR 585.75), was performed in 99.7% of patients. PVL, but not preoperative AR, was a major predictor of adverse outcome (HR 1.33, CI 95% 0.9-2.05, p=0.012 for mild PVL, HR 1.36, CI 95% 0.9-2.05, p<0.001 for PVL≥moderate and OR 1.04, p=0.97 respectively). Patients with moderate-severe PVL and preoperative left ventricle (LV) dilatation (LVEDVi>75ml/m2) showed better survival than those without dilatation (HR 8.63, p=0.001).

Conclusions: In patients with severe AS treated with balloon-expandable TAVI, the presence of PVL, but not pre-procedural AR, was a major predictor of adverse outcome. Preoperative LV dilatation seemed to offer some clinical advantages.

Keywords: Aortic valve regurgitation; Aortic valve stenosis; Paravalvular leakage; TAVI; TAVR.

Publication types

  • Multicenter Study

MeSH terms

  • Aged
  • Aged, 80 and over
  • Aortic Valve / surgery*
  • Aortic Valve Insufficiency / complications
  • Aortic Valve Insufficiency / diagnosis
  • Aortic Valve Insufficiency / mortality*
  • Aortic Valve Stenosis / complications
  • Aortic Valve Stenosis / diagnosis
  • Aortic Valve Stenosis / surgery*
  • Echocardiography
  • Female
  • Follow-Up Studies
  • Heart Valve Prosthesis / adverse effects*
  • Humans
  • Italy / epidemiology
  • Male
  • Postoperative Complications / diagnosis
  • Postoperative Complications / etiology
  • Postoperative Complications / mortality*
  • Prognosis
  • Prospective Studies
  • Prosthesis Design
  • Registries*
  • Risk Factors
  • Severity of Illness Index
  • Survival Rate / trends
  • Transcatheter Aortic Valve Replacement / adverse effects*