Impact of post-procedural aortic regurgitation on mortality after transcatheter aortic valve implantation

Kentaro Hayashida, Thierry Lefèvre, Bernard Chevalier, Thomas Hovasse, Mauro Romano, Philippe Garot, Erik Bouvier, Arnaud Farge, Patrick Donzeau-Gouge, Bertrand Cormier, Marie Claude Morice

Research output: Contribution to journalArticle

109 Citations (Scopus)

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 languageEnglish
Pages (from-to)1247-1256
Number of pages10
JournalJACC: Cardiovascular Interventions
Volume5
Issue number12
DOIs
Publication statusPublished - 2012 Dec
Externally publishedYes

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Aortic Valve Insufficiency
Mortality
Dilatation
Mitral Valve Insufficiency
Left Ventricular Function
Transcatheter Aortic Valve Replacement
Confidence Intervals

Keywords

  • aortic stenosis
  • mortality
  • paravalvular regurgitation
  • predictor
  • transcatheter aortic valve implantation

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Hayashida, K., Lefèvre, T., Chevalier, B., Hovasse, T., Romano, M., Garot, P., ... Morice, M. C. (2012). Impact of post-procedural aortic regurgitation on mortality after transcatheter aortic valve implantation. JACC: Cardiovascular Interventions, 5(12), 1247-1256. https://doi.org/10.1016/j.jcin.2012.09.003

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 journalArticle

Hayashida, K, Lefèvre, T, Chevalier, B, Hovasse, T, Romano, M, Garot, P, Bouvier, E, Farge, A, Donzeau-Gouge, P, Cormier, B & Morice, MC 2012, 'Impact of post-procedural aortic regurgitation on mortality after transcatheter aortic valve implantation', JACC: Cardiovascular Interventions, vol. 5, no. 12, pp. 1247-1256. https://doi.org/10.1016/j.jcin.2012.09.003
Hayashida, Kentaro ; Lefèvre, Thierry ; Chevalier, Bernard ; Hovasse, Thomas ; Romano, Mauro ; Garot, Philippe ; Bouvier, Erik ; Farge, Arnaud ; Donzeau-Gouge, Patrick ; Cormier, Bertrand ; Morice, Marie Claude. / Impact of post-procedural aortic regurgitation on mortality after transcatheter aortic valve implantation. In: JACC: Cardiovascular Interventions. 2012 ; Vol. 5, No. 12. pp. 1247-1256.
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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.",
keywords = "aortic stenosis, mortality, paravalvular regurgitation, predictor, transcatheter aortic valve implantation",
author = "Kentaro Hayashida and Thierry Lef{\`e}vre and Bernard Chevalier and Thomas Hovasse and Mauro Romano and Philippe Garot and Erik Bouvier and Arnaud Farge and Patrick Donzeau-Gouge and Bertrand Cormier and Morice, {Marie Claude}",
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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

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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

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