TY - JOUR
T1 - CoreValve implantation for severe aortic regurgitation
T2 - A multicentre registry
AU - Testa, Luca
AU - Latib, Azeem
AU - Rossi, Marco Luciano
AU - De Marco, Federico
AU - De Carlo, Marco
AU - Fiorina, Claudia
AU - Oreglia, Jacopo
AU - Petronio, Anna Sonia
AU - Ettori, Federica
AU - De Servi, Stefano
AU - Klugmann, Silvio
AU - Ussia, Gian Paolo
AU - Tamburino, Corrado
AU - Panisi, Paolo
AU - Brambilla, Nedy
AU - Colombo, Antonio
AU - Presbitero, Patrizia
AU - Bedogni, Francesco
N1 - Copyright:
Copyright 2018 Elsevier B.V., All rights reserved.
PY - 2014/10/1
Y1 - 2014/10/1
N2 - Aims: We sought to evaluate the outcome of transcatheter aortic valve replacement (TAVR) with the CoreValve Revalving System (CRS-TAVR) in inoperable patients presenting with severe aortic regurgitation (AR), compared to in patients treated for severe native aortic stenosis (AS).Methods and results: From October 2008 to January 2013, 1,557 consecutive patients undergoing CRS-TAVR, of whom 26 (1.6-) presented with AR, were prospectively followed. Compared with patients with AS, patients with AR were significantly younger (mean age 73±10 vs. 82±6, p=0.02), more frequently in NYHA Class III/IV (95- vs. 73-, p=0.01) and had a higher incidence of severe pulmonary hypertension (sPAP >60 mmHg, 31- vs. 10-, p=0.007). Log EuroSCORE and STS score were similar. VARC-2-defined device success was lower in the AR group (79- vs. 96-, p=0.006). At one month, patients treated for AR had a higher overall mortality (23- vs. 5.9-; OR 4.22 [3.03-8.28], p<0.001) and cardiac mortality (15.3- vs. 4-, OR 4.01 [2.40-7.66], p<0.001). Results were consistent at 12 months: overall mortality (31- vs. 19-, HR 2.1 [1.5-4.41], p<0.001) and cardiac mortality (19.2- vs. 6-, HR 3.1 [2.09-8.22], p<0.001).Conclusions: CRS-TAVR for AR is associated with a significantly higher mortality compared to CRS-TAVR for AS. Considering the ominous prognosis of these patients when treated medically, TAVR may be a reasonable choice in selected patients. In this regard, conventional risk scores have an inadequate predictive value.
AB - Aims: We sought to evaluate the outcome of transcatheter aortic valve replacement (TAVR) with the CoreValve Revalving System (CRS-TAVR) in inoperable patients presenting with severe aortic regurgitation (AR), compared to in patients treated for severe native aortic stenosis (AS).Methods and results: From October 2008 to January 2013, 1,557 consecutive patients undergoing CRS-TAVR, of whom 26 (1.6-) presented with AR, were prospectively followed. Compared with patients with AS, patients with AR were significantly younger (mean age 73±10 vs. 82±6, p=0.02), more frequently in NYHA Class III/IV (95- vs. 73-, p=0.01) and had a higher incidence of severe pulmonary hypertension (sPAP >60 mmHg, 31- vs. 10-, p=0.007). Log EuroSCORE and STS score were similar. VARC-2-defined device success was lower in the AR group (79- vs. 96-, p=0.006). At one month, patients treated for AR had a higher overall mortality (23- vs. 5.9-; OR 4.22 [3.03-8.28], p<0.001) and cardiac mortality (15.3- vs. 4-, OR 4.01 [2.40-7.66], p<0.001). Results were consistent at 12 months: overall mortality (31- vs. 19-, HR 2.1 [1.5-4.41], p<0.001) and cardiac mortality (19.2- vs. 6-, HR 3.1 [2.09-8.22], p<0.001).Conclusions: CRS-TAVR for AR is associated with a significantly higher mortality compared to CRS-TAVR for AS. Considering the ominous prognosis of these patients when treated medically, TAVR may be a reasonable choice in selected patients. In this regard, conventional risk scores have an inadequate predictive value.
KW - Aortic regurgitation
KW - Transcatheter aortic valve replacement
UR - http://www.scopus.com/inward/record.url?scp=84936758191&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84936758191&partnerID=8YFLogxK
U2 - 10.4244/EIJV10I6A127
DO - 10.4244/EIJV10I6A127
M3 - Article
C2 - 25330506
AN - SCOPUS:84936758191
VL - 10
JO - EuroIntervention
JF - EuroIntervention
SN - 1774-024X
IS - 6
ER -