Update on the clinical impact of mild aortic regurgitation after transcatheter aortic valve implantation

Insights from the Japanese multicenter OCEAN-TAVI registry

On behalf of the OCEAN-TAVI Investigators

Research output: Contribution to journalArticle

Abstract

Objectives: This study aimed to compare the clinical impact of mild postprocedural aortic regurgitation (post-AR) to that of none-trivial post-AR after transcatheter aortic valve implantation (TAVI) and to identify the vulnerability factors to mild post-AR. Background: Moderate–severe post-AR, associated with increased mortality, is an important issue. However, the clinical impact of mild post-AR remains controversial. Methods and results: We analyzed data from 1,572 consecutive patients (1,026 of none-trivial post-AR and 546 of mild post-AR) obtained from the Optimized transCathEter vAlvular Intervention (OCEAN-TAVI) Japanese multicenter registry. We evaluated the 1-year cumulative cardiovascular death and re-hospitalization rates for heart failure (HF) after TAVI according to the degree of post-AR. Kaplan–Meier curves showed no significant difference between “none-trivial post-AR” and “mild post-AR” in terms of cardiovascular death, but a significant difference was noted in the cumulative incidence of re-hospitalization for HF between the two groups (hazard ratio 1.57, 95% confidence interval 1.02–2.41, p =.04). In the stratified analysis, only in patients with not more than 50% of left ventricular ejection fraction (LVEF), concentric left ventricular hypertrophy (LVH), and none-trivial pre-procedural aortic regurgitation (pre-AR), mild post-AR resulted in a higher incidence of re-hospitalization for HF. Conclusions: In this study, the clinical impact of mild post-AR compared to none-trivial post-AR tended to be augmented in the presence of reduced LVEF, concentric LVH, and none-trivial pre-AR. Pre-procedure echocardiographic findings including LVEF, left ventricular geometry, and pre-AR may help to judge the necessity of postdilatation in case of mild post-AR just after the bioprosthesis deployment.

Original languageEnglish
JournalCatheterization and Cardiovascular Interventions
DOIs
Publication statusPublished - 2019 Jan 1

Fingerprint

Aortic Valve Insufficiency
Registries
Stroke Volume
Transcatheter Aortic Valve Replacement
Hospitalization
Heart Failure
Left Ventricular Hypertrophy
Bioprosthesis
Incidence

Keywords

  • aortic regurgitation
  • left ventricular hypertrophy
  • severe aortic stenosis
  • transcatheter aortic valve implantation

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

Cite this

@article{895e7ca8e38e4acbb7e49bc791637bdd,
title = "Update on the clinical impact of mild aortic regurgitation after transcatheter aortic valve implantation: Insights from the Japanese multicenter OCEAN-TAVI registry",
abstract = "Objectives: This study aimed to compare the clinical impact of mild postprocedural aortic regurgitation (post-AR) to that of none-trivial post-AR after transcatheter aortic valve implantation (TAVI) and to identify the vulnerability factors to mild post-AR. Background: Moderate–severe post-AR, associated with increased mortality, is an important issue. However, the clinical impact of mild post-AR remains controversial. Methods and results: We analyzed data from 1,572 consecutive patients (1,026 of none-trivial post-AR and 546 of mild post-AR) obtained from the Optimized transCathEter vAlvular Intervention (OCEAN-TAVI) Japanese multicenter registry. We evaluated the 1-year cumulative cardiovascular death and re-hospitalization rates for heart failure (HF) after TAVI according to the degree of post-AR. Kaplan–Meier curves showed no significant difference between “none-trivial post-AR” and “mild post-AR” in terms of cardiovascular death, but a significant difference was noted in the cumulative incidence of re-hospitalization for HF between the two groups (hazard ratio 1.57, 95{\%} confidence interval 1.02–2.41, p =.04). In the stratified analysis, only in patients with not more than 50{\%} of left ventricular ejection fraction (LVEF), concentric left ventricular hypertrophy (LVH), and none-trivial pre-procedural aortic regurgitation (pre-AR), mild post-AR resulted in a higher incidence of re-hospitalization for HF. Conclusions: In this study, the clinical impact of mild post-AR compared to none-trivial post-AR tended to be augmented in the presence of reduced LVEF, concentric LVH, and none-trivial pre-AR. Pre-procedure echocardiographic findings including LVEF, left ventricular geometry, and pre-AR may help to judge the necessity of postdilatation in case of mild post-AR just after the bioprosthesis deployment.",
keywords = "aortic regurgitation, left ventricular hypertrophy, severe aortic stenosis, transcatheter aortic valve implantation",
author = "{On behalf of the OCEAN-TAVI Investigators} and Nobuhiro Yoshijima and Ryo Yanagisawa and Hiromu Hase and Makoto Tanaka and Hikaru Tsuruta and Hideyuki Shimizu and Keiichi Fukuda and Toru Naganuma and Kazuki Mizutani and Motoharu Araki and Norio Tada and Futoshi Yamanaka and Shinichi Shirai and Minoru Tabata and Hiroshi Ueno and Kensuke Takagi and Akihiro Higashimori and Yusuke Watanabe and Masanori Yamamoto and Kentaro Hayashida",
year = "2019",
month = "1",
day = "1",
doi = "10.1002/ccd.28279",
language = "English",
journal = "Catheterization and Cardiovascular Interventions",
issn = "1522-1946",
publisher = "Wiley-Liss Inc.",

}

TY - JOUR

T1 - Update on the clinical impact of mild aortic regurgitation after transcatheter aortic valve implantation

T2 - Insights from the Japanese multicenter OCEAN-TAVI registry

AU - On behalf of the OCEAN-TAVI Investigators

AU - Yoshijima, Nobuhiro

AU - Yanagisawa, Ryo

AU - Hase, Hiromu

AU - Tanaka, Makoto

AU - Tsuruta, Hikaru

AU - Shimizu, Hideyuki

AU - Fukuda, Keiichi

AU - Naganuma, Toru

AU - Mizutani, Kazuki

AU - Araki, Motoharu

AU - Tada, Norio

AU - Yamanaka, Futoshi

AU - Shirai, Shinichi

AU - Tabata, Minoru

AU - Ueno, Hiroshi

AU - Takagi, Kensuke

AU - Higashimori, Akihiro

AU - Watanabe, Yusuke

AU - Yamamoto, Masanori

AU - Hayashida, Kentaro

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Objectives: This study aimed to compare the clinical impact of mild postprocedural aortic regurgitation (post-AR) to that of none-trivial post-AR after transcatheter aortic valve implantation (TAVI) and to identify the vulnerability factors to mild post-AR. Background: Moderate–severe post-AR, associated with increased mortality, is an important issue. However, the clinical impact of mild post-AR remains controversial. Methods and results: We analyzed data from 1,572 consecutive patients (1,026 of none-trivial post-AR and 546 of mild post-AR) obtained from the Optimized transCathEter vAlvular Intervention (OCEAN-TAVI) Japanese multicenter registry. We evaluated the 1-year cumulative cardiovascular death and re-hospitalization rates for heart failure (HF) after TAVI according to the degree of post-AR. Kaplan–Meier curves showed no significant difference between “none-trivial post-AR” and “mild post-AR” in terms of cardiovascular death, but a significant difference was noted in the cumulative incidence of re-hospitalization for HF between the two groups (hazard ratio 1.57, 95% confidence interval 1.02–2.41, p =.04). In the stratified analysis, only in patients with not more than 50% of left ventricular ejection fraction (LVEF), concentric left ventricular hypertrophy (LVH), and none-trivial pre-procedural aortic regurgitation (pre-AR), mild post-AR resulted in a higher incidence of re-hospitalization for HF. Conclusions: In this study, the clinical impact of mild post-AR compared to none-trivial post-AR tended to be augmented in the presence of reduced LVEF, concentric LVH, and none-trivial pre-AR. Pre-procedure echocardiographic findings including LVEF, left ventricular geometry, and pre-AR may help to judge the necessity of postdilatation in case of mild post-AR just after the bioprosthesis deployment.

AB - Objectives: This study aimed to compare the clinical impact of mild postprocedural aortic regurgitation (post-AR) to that of none-trivial post-AR after transcatheter aortic valve implantation (TAVI) and to identify the vulnerability factors to mild post-AR. Background: Moderate–severe post-AR, associated with increased mortality, is an important issue. However, the clinical impact of mild post-AR remains controversial. Methods and results: We analyzed data from 1,572 consecutive patients (1,026 of none-trivial post-AR and 546 of mild post-AR) obtained from the Optimized transCathEter vAlvular Intervention (OCEAN-TAVI) Japanese multicenter registry. We evaluated the 1-year cumulative cardiovascular death and re-hospitalization rates for heart failure (HF) after TAVI according to the degree of post-AR. Kaplan–Meier curves showed no significant difference between “none-trivial post-AR” and “mild post-AR” in terms of cardiovascular death, but a significant difference was noted in the cumulative incidence of re-hospitalization for HF between the two groups (hazard ratio 1.57, 95% confidence interval 1.02–2.41, p =.04). In the stratified analysis, only in patients with not more than 50% of left ventricular ejection fraction (LVEF), concentric left ventricular hypertrophy (LVH), and none-trivial pre-procedural aortic regurgitation (pre-AR), mild post-AR resulted in a higher incidence of re-hospitalization for HF. Conclusions: In this study, the clinical impact of mild post-AR compared to none-trivial post-AR tended to be augmented in the presence of reduced LVEF, concentric LVH, and none-trivial pre-AR. Pre-procedure echocardiographic findings including LVEF, left ventricular geometry, and pre-AR may help to judge the necessity of postdilatation in case of mild post-AR just after the bioprosthesis deployment.

KW - aortic regurgitation

KW - left ventricular hypertrophy

KW - severe aortic stenosis

KW - transcatheter aortic valve implantation

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U2 - 10.1002/ccd.28279

DO - 10.1002/ccd.28279

M3 - Article

JO - Catheterization and Cardiovascular Interventions

JF - Catheterization and Cardiovascular Interventions

SN - 1522-1946

ER -