Impact and natural history of postprocedural aortic regurgitation on early and midterm mortality following transcatheter aortic valve implantation in high-risk patients with severe aortic stenosis.

Abstract

BACKGROUND:

Post-procedural aortic regurgitation (AR) negatively impacts the prognosis after trans-catheter aortic valve implantation. However, data evaluating the impact of different post-procedural AR grades (particularly mild) on clinical outcomes are still important.

AIM AND METHODS:

A retrospective cohort analysis was performed on all consecutive patients with severe aortic stenosis who underwent trans-catheter aortic valve implantation between July 2008 and August 2011 in a single Institution. Aim of the study was to evaluate the impact of different post-procedural AR grades on early and mid-term clinical outcomes.

RESULTS:

322 consecutive patients were evaluated. At post-procedural echocardiographic evaluation: 105 (32.6%) patients had no AR, 204 (63.4%) mild AR and 13 (4%) moderate/severe AR. In-hospital mortality was higher in patients with moderate/severe AR than in those with absent or mild AR (38.5% vs. 2.6%, P < 0.001). At a median clinical follow-up of 342 days [interquartile range 93-485] cardiovascular mortality was 2.9% in patients without AR; 13.2% in the mild AR group (P = 0.004 vs. absent AR) and 46.2% in the moderate/severe AR group (P < 0.001 vs. mild or absent AR). On multivariable analysis, post-procedural AR (hazard ratio = 2.65 absent vs. present any grade, 95% confidence interval = 1.11-6.29; P = 0.027) was an independent predictor of mid-term mortality.

CONCLUSIONS:

The impact of post-procedural AR on outcomes after trans-catheter aortic valve implantation is proportional with its grade even in case of mild post-procedural AR compared to absent. This study confirms that every effort should be made to reduce the grade of post-procedural AR after trans-catheter aortic valve implantation with current devices.

• Authors: Alfonso Ielasi, Azeem Latib, Francesco Maria Sacco, Charis Costopoulos, Filippo Figini, Antonio Grimaldi, Charbel Naim, Francesco Maisano, Alaide Chieffo, Matteo Montorfano, Ottavio Alfieri, Antonio Colombo
• Journal: Journal of cardiovascular medicine (Hagerstown, Md.) (J Cardiovasc Med (Hagerstown)) Vol. 16 Issue 4 Pg. 286-95 (Apr 2015) ISSN: 1558-2035 [Electronic] United States
• PMID: 25643194 (Publication Type: Journal Article)

Topics

• Aged
• Aged, 80 and over
• Aortic Valve (pathology, surgery)
• Aortic Valve Insufficiency (epidemiology, etiology, mortality, physiopathology)
• Aortic Valve Stenosis (physiopathology, surgery)
• Cardiac Catheterization (methods)
• Female
• Follow-Up Studies
• Hospital Mortality
• Humans
• Male
• Postoperative Complications (mortality)
• Prognosis
• Retrospective Studies
• Risk Factors
• Severity of Illness Index
• Time Factors
• Transcatheter Aortic Valve Replacement (adverse effects, methods, mortality)
• Treatment Outcome