Abstract
Objectives: The goal of the study was to clarify the impact of post-procedural aortic regurgitation (post-AR) grade 2/4 on clinical outcomes. Background: Post-AR >2/4 is known to be associated with poor short- to midterm outcome after transcatheter aortic valve implantation (TAVI). Methods: We compared clinical outcomes in 400 consecutive TAVI recipients according to post-AR grade: grade 0 or 1 (group 1 = 74.8%), grade 2 (group 2 = 22.2%), or grade 3 or 4 (group 3 = 3.0%). Results: The mean age was similar in the 3 groups (83.4 ± 6.1 years) as was the logistic EuroSCORE (22.5 ± 11.4%, 24.5 ± 11.6%, and 21.5 ± 9.4%, p = 0.28) and annulus size (22.0 ± 1.8, 22.2 ± 2.1, and 22.5 ± 2.1 mm, p = 0.53). The Edwards valve was most frequently used in group 1 compared with groups 2 and 3 (89.3%, 78.7%, and 83.3%, p = 0.03), and the implanted valve size was similar in all groups (25.6 ± 2.0, 25.4 ± 2.2, and 25.5 ± 2.2 mm, respectively, p = 0.69). Post-dilation was required more frequently in group 3 (4.7%, 24.1%, and 50.0%, respectively, p < 0.01). Post-procedural increase in mitral regurgitation was in line with the post-AR grade (0.78 ± 0.73, 1.22 ± 0.80, and 1.89 ± 0.78, respectively, p < 0.01). Despite the absence of difference in 30-day mortality, longer-term outcome was significantly poorer in patients with AR grade 2 than in those with AR grade 0 or 1 (log-rank p < 0.01), albeit better than in patients with AR grade 3 or 4 (p = 0.04), regardless of TAVI type and left ventricular function. Post-AR ≥2/4 was also identified as an independent predictor of mid- to long-term mortality (hazard ratio: 1.68, 95% confidence interval: 1.21 to 1.44, p < 0.01). Conclusions: Post-AR grade 2/4 after TAVI is associated with worse outcome compared with grade 0 or 1. Careful valve selection and post-dilation when required to avoid post-AR grade 2 may contribute to improved clinical outcome after TAVI.
| Original language | English |
|---|---|
| Pages (from-to) | 1247-1256 |
| Number of pages | 10 |
| Journal | JACC: Cardiovascular Interventions |
| Volume | 5 |
| Issue number | 12 |
| DOIs | |
| Publication status | Published - 2012 Dec |
| Externally published | Yes |
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Keywords
- aortic stenosis
- mortality
- paravalvular regurgitation
- predictor
- transcatheter aortic valve implantation
ASJC Scopus subject areas
- Cardiology and Cardiovascular Medicine
Cite this
Impact of post-procedural aortic regurgitation on mortality after transcatheter aortic valve implantation. / Hayashida, Kentaro; Lefèvre, Thierry; Chevalier, Bernard; Hovasse, Thomas; Romano, Mauro; Garot, Philippe; Bouvier, Erik; Farge, Arnaud; Donzeau-Gouge, Patrick; Cormier, Bertrand; Morice, Marie Claude.
In: JACC: Cardiovascular Interventions, Vol. 5, No. 12, 12.2012, p. 1247-1256.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Impact of post-procedural aortic regurgitation on mortality after transcatheter aortic valve implantation
AU - Hayashida, Kentaro
AU - Lefèvre, Thierry
AU - Chevalier, Bernard
AU - Hovasse, Thomas
AU - Romano, Mauro
AU - Garot, Philippe
AU - Bouvier, Erik
AU - Farge, Arnaud
AU - Donzeau-Gouge, Patrick
AU - Cormier, Bertrand
AU - Morice, Marie Claude
PY - 2012/12
Y1 - 2012/12
N2 - Objectives: The goal of the study was to clarify the impact of post-procedural aortic regurgitation (post-AR) grade 2/4 on clinical outcomes. Background: Post-AR >2/4 is known to be associated with poor short- to midterm outcome after transcatheter aortic valve implantation (TAVI). Methods: We compared clinical outcomes in 400 consecutive TAVI recipients according to post-AR grade: grade 0 or 1 (group 1 = 74.8%), grade 2 (group 2 = 22.2%), or grade 3 or 4 (group 3 = 3.0%). Results: The mean age was similar in the 3 groups (83.4 ± 6.1 years) as was the logistic EuroSCORE (22.5 ± 11.4%, 24.5 ± 11.6%, and 21.5 ± 9.4%, p = 0.28) and annulus size (22.0 ± 1.8, 22.2 ± 2.1, and 22.5 ± 2.1 mm, p = 0.53). The Edwards valve was most frequently used in group 1 compared with groups 2 and 3 (89.3%, 78.7%, and 83.3%, p = 0.03), and the implanted valve size was similar in all groups (25.6 ± 2.0, 25.4 ± 2.2, and 25.5 ± 2.2 mm, respectively, p = 0.69). Post-dilation was required more frequently in group 3 (4.7%, 24.1%, and 50.0%, respectively, p < 0.01). Post-procedural increase in mitral regurgitation was in line with the post-AR grade (0.78 ± 0.73, 1.22 ± 0.80, and 1.89 ± 0.78, respectively, p < 0.01). Despite the absence of difference in 30-day mortality, longer-term outcome was significantly poorer in patients with AR grade 2 than in those with AR grade 0 or 1 (log-rank p < 0.01), albeit better than in patients with AR grade 3 or 4 (p = 0.04), regardless of TAVI type and left ventricular function. Post-AR ≥2/4 was also identified as an independent predictor of mid- to long-term mortality (hazard ratio: 1.68, 95% confidence interval: 1.21 to 1.44, p < 0.01). Conclusions: Post-AR grade 2/4 after TAVI is associated with worse outcome compared with grade 0 or 1. Careful valve selection and post-dilation when required to avoid post-AR grade 2 may contribute to improved clinical outcome after TAVI.
AB - Objectives: The goal of the study was to clarify the impact of post-procedural aortic regurgitation (post-AR) grade 2/4 on clinical outcomes. Background: Post-AR >2/4 is known to be associated with poor short- to midterm outcome after transcatheter aortic valve implantation (TAVI). Methods: We compared clinical outcomes in 400 consecutive TAVI recipients according to post-AR grade: grade 0 or 1 (group 1 = 74.8%), grade 2 (group 2 = 22.2%), or grade 3 or 4 (group 3 = 3.0%). Results: The mean age was similar in the 3 groups (83.4 ± 6.1 years) as was the logistic EuroSCORE (22.5 ± 11.4%, 24.5 ± 11.6%, and 21.5 ± 9.4%, p = 0.28) and annulus size (22.0 ± 1.8, 22.2 ± 2.1, and 22.5 ± 2.1 mm, p = 0.53). The Edwards valve was most frequently used in group 1 compared with groups 2 and 3 (89.3%, 78.7%, and 83.3%, p = 0.03), and the implanted valve size was similar in all groups (25.6 ± 2.0, 25.4 ± 2.2, and 25.5 ± 2.2 mm, respectively, p = 0.69). Post-dilation was required more frequently in group 3 (4.7%, 24.1%, and 50.0%, respectively, p < 0.01). Post-procedural increase in mitral regurgitation was in line with the post-AR grade (0.78 ± 0.73, 1.22 ± 0.80, and 1.89 ± 0.78, respectively, p < 0.01). Despite the absence of difference in 30-day mortality, longer-term outcome was significantly poorer in patients with AR grade 2 than in those with AR grade 0 or 1 (log-rank p < 0.01), albeit better than in patients with AR grade 3 or 4 (p = 0.04), regardless of TAVI type and left ventricular function. Post-AR ≥2/4 was also identified as an independent predictor of mid- to long-term mortality (hazard ratio: 1.68, 95% confidence interval: 1.21 to 1.44, p < 0.01). Conclusions: Post-AR grade 2/4 after TAVI is associated with worse outcome compared with grade 0 or 1. Careful valve selection and post-dilation when required to avoid post-AR grade 2 may contribute to improved clinical outcome after TAVI.
KW - aortic stenosis
KW - mortality
KW - paravalvular regurgitation
KW - predictor
KW - transcatheter aortic valve implantation
UR - http://www.scopus.com/inward/record.url?scp=84871290564&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84871290564&partnerID=8YFLogxK
U2 - 10.1016/j.jcin.2012.09.003
DO - 10.1016/j.jcin.2012.09.003
M3 - Article
C2 - 23257373
AN - SCOPUS:84871290564
VL - 5
SP - 1247
EP - 1256
JO - JACC: Cardiovascular Interventions
JF - JACC: Cardiovascular Interventions
SN - 1936-8798
IS - 12
ER -