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Device-dependent association between paravalvar aortic regurgitation and outcome after TAVI.
- Source :
-
Heart (British Cardiac Society) [Heart] 2014 Dec; Vol. 100 (24), pp. 1939-45. Date of Electronic Publication: 2014 Jul 22. - Publication Year :
- 2014
-
Abstract
- Objective: The aim of the current study was to identify predictors of paraprosthetic aortic regurgitation (AR) after transcatheter aortic valve implantation (TAVI) and examine its influence on short/medium-term mortality using the UK TAVI Registry. TAVI is an effective treatment for high-risk patients with severe symptomatic aortic stenosis (AS), but paraprosthetic AR has been associated with increased in-hospital and mid-term mortality.<br />Methods: Between January 2007 and December 2011, 2584 TAVI procedures were performed in the UK. Patients undergoing 'valve-in-valve' procedures, patients with aortic regurgitation as the primary pathology and with no recorded severity of AR were excluded from this analysis (n=144). In total, therefore, 2440 patients were included. Balloon-expandable and self-expanding devices were implanted in 52.7 and 47.2%, respectively, using either transfemoral (67.7%) or non-transfemoral, surgical access (32.3%).<br />Results: Postprocedural AR was observed in 68%, mild AR in 57% and moderate-severe in 10%. A large aortic annulus, high preprocedural transaortic gradient, and use of self-expanding valve were independent predictors of moderate-severe AR. Moderate-severe (but not mild) AR was associated with increased mortality, and this relationship appeared significant for the balloon-expandable but not the self-expanding device.<br />Conclusions: Our data suggest that a large aortic annulus, high preprocedural transaortic gradient, and use of the self-expanding valve predict moderate-severe AR after TAVI. Such a degree of AR is associated with a significantly worse outcome with the balloon-expandable, but not with the self-expanding valve. Further studies are needed to verify this and explore potential mechanisms.<br /> (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.)
- Subjects :
- Aged, 80 and over
Analysis of Variance
Aortic Valve Insufficiency mortality
Aortic Valve Insufficiency pathology
Aortic Valve Stenosis mortality
Aortic Valve Stenosis surgery
Balloon Valvuloplasty adverse effects
Balloon Valvuloplasty mortality
Female
Humans
Kaplan-Meier Estimate
Male
Postoperative Complications etiology
Postoperative Complications mortality
Postoperative Complications pathology
Prospective Studies
Transcatheter Aortic Valve Replacement mortality
Aortic Valve pathology
Aortic Valve Insufficiency etiology
Heart Valve Prosthesis adverse effects
Transcatheter Aortic Valve Replacement adverse effects
Subjects
Details
- Language :
- English
- ISSN :
- 1468-201X
- Volume :
- 100
- Issue :
- 24
- Database :
- MEDLINE
- Journal :
- Heart (British Cardiac Society)
- Publication Type :
- Academic Journal
- Accession number :
- 25053724
- Full Text :
- https://doi.org/10.1136/heartjnl-2013-305390