Clinical impact of aortic regurgitation after transcatheter aortic valve replacement: Insights into the degree and acuteness of presentation

Miguel Jerez-Valero, Marina Urena, John G. Webb, Corrado Tamburino, Antonio J. Munoz-Garcia, Asim Cheema, Antonio E. Dager, Vicenç Serra, Ignacio J. Amat-Santos, Marco Barbanti, Sebastiano Immè, Juan H. Alonso Briales, Hatim Al Lawati, Luis Miguel Benitez, Angela Maria Cucalon, Bruno Garcia Del Blanco, Ana Revilla, Eric Dumont, Henrique Barbosa Ribeiro, Luis Nombela-FrancoSébastien Bergeron, Philippe Pibarot, Josep Rodés-Cabau

Research output: Contribution to journalArticle

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Abstract

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.

Original languageEnglish
Pages (from-to)1022-1032
Number of pages11
JournalJACC: Cardiovascular Interventions
Volume7
Issue number9
DOIs
Publication statusPublished - Sep 1 2014

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Aortic Valve Insufficiency
Echocardiography
Mortality
Transcatheter Aortic Valve Replacement
Confidence Intervals

Keywords

  • acute aortic regurgitation
  • aortic regurgitation
  • mitral regurgitation
  • paravalvular leak
  • transcatheter aortic valve implantation
  • transcatheter aortic valve replacement

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Clinical impact of aortic regurgitation after transcatheter aortic valve replacement : Insights into the degree and acuteness of presentation. / Jerez-Valero, Miguel; Urena, Marina; Webb, John G.; Tamburino, Corrado; Munoz-Garcia, Antonio J.; Cheema, Asim; Dager, Antonio E.; Serra, Vicenç; Amat-Santos, Ignacio J.; Barbanti, Marco; Immè, Sebastiano; Alonso Briales, Juan H.; Al Lawati, Hatim; Benitez, Luis Miguel; Cucalon, Angela Maria; Garcia Del Blanco, Bruno; Revilla, Ana; Dumont, Eric; Barbosa Ribeiro, Henrique; Nombela-Franco, Luis; Bergeron, Sébastien; Pibarot, Philippe; Rodés-Cabau, Josep.

In: JACC: Cardiovascular Interventions, Vol. 7, No. 9, 01.09.2014, p. 1022-1032.

Research output: Contribution to journalArticle

Jerez-Valero, M, Urena, M, Webb, JG, Tamburino, C, Munoz-Garcia, AJ, Cheema, A, Dager, AE, Serra, V, Amat-Santos, IJ, Barbanti, M, Immè, S, Alonso Briales, JH, Al Lawati, H, Benitez, LM, Cucalon, AM, Garcia Del Blanco, B, Revilla, A, Dumont, E, Barbosa Ribeiro, H, Nombela-Franco, L, Bergeron, S, Pibarot, P & Rodés-Cabau, J 2014, 'Clinical impact of aortic regurgitation after transcatheter aortic valve replacement: Insights into the degree and acuteness of presentation', JACC: Cardiovascular Interventions, vol. 7, no. 9, pp. 1022-1032. https://doi.org/10.1016/j.jcin.2014.04.012
Jerez-Valero, Miguel ; Urena, Marina ; Webb, John G. ; Tamburino, Corrado ; Munoz-Garcia, Antonio J. ; Cheema, Asim ; Dager, Antonio E. ; Serra, Vicenç ; Amat-Santos, Ignacio J. ; Barbanti, Marco ; Immè, Sebastiano ; Alonso Briales, Juan H. ; Al Lawati, Hatim ; Benitez, Luis Miguel ; Cucalon, Angela Maria ; Garcia Del Blanco, Bruno ; Revilla, Ana ; Dumont, Eric ; Barbosa Ribeiro, Henrique ; Nombela-Franco, Luis ; Bergeron, Sébastien ; Pibarot, Philippe ; Rodés-Cabau, Josep. / Clinical impact of aortic regurgitation after transcatheter aortic valve replacement : Insights into the degree and acuteness of presentation. In: JACC: Cardiovascular Interventions. 2014 ; Vol. 7, No. 9. pp. 1022-1032.
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abstract = "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.",
keywords = "acute aortic regurgitation, aortic regurgitation, mitral regurgitation, paravalvular leak, transcatheter aortic valve implantation, transcatheter aortic valve replacement",
author = "Miguel Jerez-Valero and Marina Urena and Webb, {John G.} and Corrado Tamburino and Munoz-Garcia, {Antonio J.} and Asim Cheema and Dager, {Antonio E.} and Vicen{\cc} Serra and Amat-Santos, {Ignacio J.} and Marco Barbanti and Sebastiano Imm{\`e} and {Alonso Briales}, {Juan H.} and {Al Lawati}, Hatim and Benitez, {Luis Miguel} and Cucalon, {Angela Maria} and {Garcia Del Blanco}, Bruno and Ana Revilla and Eric Dumont and {Barbosa Ribeiro}, Henrique and Luis Nombela-Franco and S{\'e}bastien Bergeron and Philippe Pibarot and Josep Rod{\'e}s-Cabau",
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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

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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