TY - JOUR
T1 - Incidence, predictors, and outcomes of aortic regurgitation after transcatheter aortic valve replacement
T2 - Meta-analysis and systematic review of literature
AU - Athappan, Ganesh
AU - Patvardhan, Eshan
AU - Tuzcu, E. Murat
AU - Svensson, Lars Georg
AU - Lemos, Pedro A.
AU - Fraccaro, Chiara
AU - Tarantini, Giuseppe
AU - Sinning, Jan Malte
AU - Nickenig, Georg
AU - Capodanno, Davide
AU - Tamburino, Corrado
AU - Latib, Azeem
AU - Colombo, Antonio
AU - Kapadia, Samir R.
N1 - Copyright:
Copyright 2018 Elsevier B.V., All rights reserved.
PY - 2013/4/16
Y1 - 2013/4/16
N2 - Objectives: This study was designed to establish the incidence, impact, and predictors of post-transcatheter aortic valve replacement (TAVR) aortic regurgitation (AR). Background: AR is an important limitation of TAVR with ill-defined predictors and unclear long-term impact on outcomes. Methods: Studies published between 2002 and 2012 with regard to TAVR were identified using an electronic search and reviewed using the random-effects model of DerSimonian and Laird. From 3,871 initial citations, 45 studies reporting on 12,926 patients (CoreValve [Medtronic CV Luxembourg S.a.r.l., Tolochenaz, Switzerland] n = 5,261 and Edwards valve [Edwards Lifesciences, Santa Ana, California] n = 7,279) were included in the analysis of incidence and outcomes of post-TAVR AR. Results: The pooled estimate for moderate or severe AR post-TAVR was 11.7% (95% confidence interval [CI]: 9.6 to 14.1). Moderate or severe AR was more common with use of the CoreValve (16.0% vs. 9.1%, p = 0.005). The presence of moderate or severe AR post-TAVR increased mortality at 30 days (odds ratio: 2.95; 95% CI: 1.73 to 5.02) and 1 year (hazard ratio: 2.27; 95% CI: -1.84 to 2.81). Mild AR was also associated with an increased hazard ratio for mortality, 1.829 (95% CI: 1.005 to 3.329) that was overturned by sensitivity analysis. Twenty-five studies reported on predictors of post-TAVR AR. Implantation depth, valve undersizing, and Agatston calcium score (r = 0.47, p = 0.001) were identified as important predictors. Conclusions: Moderate or severe aortic regurgitation is common after TAVR and an adverse prognostic indicator of short- and long-term survival. Incidence of moderate or severe AR is higher with use of the CoreValve. Mild AR may be associated with increased long-term mortality. Therefore, every effort should be made to minimize AR by a comprehensive pre-procedural planning and meticulous procedural execution.
AB - Objectives: This study was designed to establish the incidence, impact, and predictors of post-transcatheter aortic valve replacement (TAVR) aortic regurgitation (AR). Background: AR is an important limitation of TAVR with ill-defined predictors and unclear long-term impact on outcomes. Methods: Studies published between 2002 and 2012 with regard to TAVR were identified using an electronic search and reviewed using the random-effects model of DerSimonian and Laird. From 3,871 initial citations, 45 studies reporting on 12,926 patients (CoreValve [Medtronic CV Luxembourg S.a.r.l., Tolochenaz, Switzerland] n = 5,261 and Edwards valve [Edwards Lifesciences, Santa Ana, California] n = 7,279) were included in the analysis of incidence and outcomes of post-TAVR AR. Results: The pooled estimate for moderate or severe AR post-TAVR was 11.7% (95% confidence interval [CI]: 9.6 to 14.1). Moderate or severe AR was more common with use of the CoreValve (16.0% vs. 9.1%, p = 0.005). The presence of moderate or severe AR post-TAVR increased mortality at 30 days (odds ratio: 2.95; 95% CI: 1.73 to 5.02) and 1 year (hazard ratio: 2.27; 95% CI: -1.84 to 2.81). Mild AR was also associated with an increased hazard ratio for mortality, 1.829 (95% CI: 1.005 to 3.329) that was overturned by sensitivity analysis. Twenty-five studies reported on predictors of post-TAVR AR. Implantation depth, valve undersizing, and Agatston calcium score (r = 0.47, p = 0.001) were identified as important predictors. Conclusions: Moderate or severe aortic regurgitation is common after TAVR and an adverse prognostic indicator of short- and long-term survival. Incidence of moderate or severe AR is higher with use of the CoreValve. Mild AR may be associated with increased long-term mortality. Therefore, every effort should be made to minimize AR by a comprehensive pre-procedural planning and meticulous procedural execution.
KW - CoreValve
KW - TAVI
KW - mild AR
KW - post-TAVR AR
KW - predictors of AR post-TAVR
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U2 - 10.1016/j.jacc.2013.01.047
DO - 10.1016/j.jacc.2013.01.047
M3 - Article
C2 - 23500308
AN - SCOPUS:84875975723
SN - 0735-1097
VL - 61
SP - 1585
EP - 1595
JO - Journal of the American College of Cardiology
JF - Journal of the American College of Cardiology
IS - 15
ER -