TY - JOUR
T1 - Clinical impact of aortic regurgitation after transcatheter aortic valve replacement
T2 - Insights into the degree and acuteness of presentation
AU - Jerez-Valero, Miguel
AU - Urena, Marina
AU - Webb, John G.
AU - Tamburino, Corrado
AU - Munoz-Garcia, Antonio J.
AU - Cheema, Asim
AU - Dager, Antonio E.
AU - Serra, Vicenç
AU - Amat-Santos, Ignacio J.
AU - Barbanti, Marco
AU - Immè, Sebastiano
AU - Alonso Briales, Juan H.
AU - Al Lawati, Hatim
AU - Benitez, Luis Miguel
AU - Cucalon, Angela Maria
AU - Garcia Del Blanco, Bruno
AU - Revilla, Ana
AU - Dumont, Eric
AU - Barbosa Ribeiro, Henrique
AU - Nombela-Franco, Luis
AU - Bergeron, Sébastien
AU - Pibarot, Philippe
AU - Rodés-Cabau, Josep
N1 - Funding Information:
Dr. Jerez-Valero received funding via a grant from the College of Physicians of Toledo , Toledo, Spain. Dr. Urena received funding via a grant from Laval University , Quebec, Canada. Dr. Barbosa Ribeiro was supported by a research PhD grant from “CNPq, Conselho Nacional de Desenvolvimento Científico e Tecnológico – Brasil. Dr. Amat-Santos was supported by a grant from the Instituto de Salud Carlos III , Madrid, Spain. Dr. Rodés-Cabau is consultant for Edwards Lifesciences and St. Jude Medical. Drs. Webb and Dumont are consultants for Edwards Lifesciences. Dr. Conrado Tamburino is consultant for Edwards Lifesciences, Medtronic, CeloNova, and Abbott. Dr. Pibarot has received a research grant from Edwards Lifesciences . Dr. Dager is a proctor for Medtronic. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. Dr. Jerez-Valero and Dr. Urena contributed equally to this work.
Publisher Copyright:
© 2014 American College of Cardiology Foundation.
PY - 2014/9/1
Y1 - 2014/9/1
N2 - Objectives The aim of this study was to determine the impact of the degree of residual aortic regurgitation (AR) and acuteness of presentation of AR after transcatheter aortic valve replacement (TAVR) on outcomes. Background The degree of residual AR after TAVR leading to excess mortality remains controversial, and little evidence exists on the impact of the acuteness of presentation of AR. Methods A total of 1,735 patients undergoing TAVR with balloon-expandable or self-expanding valves were included. The presence and degree of AR were evaluated by transthoracic echocardiography; acute AR was defined as an increase in AR severity of ≥ 1 degree compared with pre-procedural echocardiography.Results Residual AR was classified as mild in 761 patients (43.9%) and moderate to severe in 247 patients (14.2%). The presence of moderate to severe AR was an independent predictor of mortality at a mean follow-up of 21 ± 17 months compared with none to trace (adjusted hazard ratio [HR]: 1.81, 95% confidence interval [CI]: 1.32 to 2.48; p < 0.001) and mild AR (adjusted HR: 1.68, 95% CI: 1.27 to 2.24; p < 0.001) groups. There was no increased risk in patients with mild AR compared with those with none to trace AR (p = 0.393). In patients with moderate to severe AR, acute AR was observed in 161 patients (65%) and chronic AR in 86 patients (35%). Acute moderate to severe AR was independently associated with increased risk of mortality compared with none/trace/mild AR (adjusted HR: 2.37, 95% CI: 1.53 to 3.66; p < 0.001) and chronic moderate to severe AR (adjusted HR: 2.24, 95% CI: 1.17 to 4.30; p = 0.015). No differences in survival rate were observed between patients with chronic moderate to severe and none/trace/mild AR (p > 0.50).Conclusions AR occurred very frequently after TAVR, but an increased risk of mortality at ∼2-year follow-up was observed only in patients with acute moderate to severe AR.
AB - Objectives The aim of this study was to determine the impact of the degree of residual aortic regurgitation (AR) and acuteness of presentation of AR after transcatheter aortic valve replacement (TAVR) on outcomes. Background The degree of residual AR after TAVR leading to excess mortality remains controversial, and little evidence exists on the impact of the acuteness of presentation of AR. Methods A total of 1,735 patients undergoing TAVR with balloon-expandable or self-expanding valves were included. The presence and degree of AR were evaluated by transthoracic echocardiography; acute AR was defined as an increase in AR severity of ≥ 1 degree compared with pre-procedural echocardiography.Results Residual AR was classified as mild in 761 patients (43.9%) and moderate to severe in 247 patients (14.2%). The presence of moderate to severe AR was an independent predictor of mortality at a mean follow-up of 21 ± 17 months compared with none to trace (adjusted hazard ratio [HR]: 1.81, 95% confidence interval [CI]: 1.32 to 2.48; p < 0.001) and mild AR (adjusted HR: 1.68, 95% CI: 1.27 to 2.24; p < 0.001) groups. There was no increased risk in patients with mild AR compared with those with none to trace AR (p = 0.393). In patients with moderate to severe AR, acute AR was observed in 161 patients (65%) and chronic AR in 86 patients (35%). Acute moderate to severe AR was independently associated with increased risk of mortality compared with none/trace/mild AR (adjusted HR: 2.37, 95% CI: 1.53 to 3.66; p < 0.001) and chronic moderate to severe AR (adjusted HR: 2.24, 95% CI: 1.17 to 4.30; p = 0.015). No differences in survival rate were observed between patients with chronic moderate to severe and none/trace/mild AR (p > 0.50).Conclusions AR occurred very frequently after TAVR, but an increased risk of mortality at ∼2-year follow-up was observed only in patients with acute moderate to severe AR.
KW - acute aortic regurgitation
KW - aortic regurgitation
KW - mitral regurgitation
KW - paravalvular leak
KW - transcatheter aortic valve implantation
KW - transcatheter aortic valve replacement
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U2 - 10.1016/j.jcin.2014.04.012
DO - 10.1016/j.jcin.2014.04.012
M3 - Article
C2 - 25234675
AN - SCOPUS:84908145898
SN - 1936-8798
VL - 7
SP - 1022
EP - 1032
JO - JACC: Cardiovascular Interventions
JF - JACC: Cardiovascular Interventions
IS - 9
ER -