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

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

Research output: Contribution to journalArticlepeer-review

1 Scopus citations

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.

Original languageEnglish (US)
Pages (from-to)286-295
Number of pages10
JournalJournal of Cardiovascular Medicine
Volume16
Issue number4
DOIs
StatePublished - Apr 4 2015
Externally publishedYes

Keywords

  • aortic regurgitation
  • aortic stenosis
  • transcatheter aortic valve implantation

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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