Does pre-existing aortic regurgitation protect from death in patients who develop paravalvular leak after TAVI?

Andrea Colli, L Besola, S Salizzoni, Dario Gregori, Giuseppe Tarantini, M Agrifoglio, A Chieffo, T Regesta, D Gabbieri, F Saia, C Tamburino, F Ribichini, Orazio Valsecchi, B Loi, Alessandro Iadanza, M Stolcova, A Minati, G Martinelli, F Bedogni, Anna Sonia PetronioM Dallago, A Cappai, A D'Onofrio, Gino Gerosa, Mauro Rinaldi

Research output: Contribution to journalArticlepeer-review

Abstract

Objective The aim of this study was to investigate interactions among pre-procedural aortic regurgitation (AR), post-procedural paravalvular leak (PVL) and long-term clinical outcomes. Methods and results We analyzed data prospectively collected in the Italian Transcatheter balloon-Expandable Registry (ITER) on aortic stenosis (AS) patients. The degree of pre-procedural AR and post-procedural PVL was stratified as: absent/trivial, mild, and moderate/severe. VARC definitions were applied to outcomes. Of 1708 patients, preoperatively, AR was absent/trivial in 40% of the patients, mild in 42%, and moderate in 18%. Postoperatively, PVL was moderate–severe in 5%, mild in 32% of patients, and absent/trivial in 63%. Clinical follow-up, median 821 days (IQR 585.75), was performed in 99.7% of patients. PVL, but not preoperative AR, was a major predictor of adverse outcome (HR 1.33, CI 95% 0.9–2.05, p = 0.012 for mild PVL, HR 1.36, CI 95% 0.9–2.05, p  75 ml/m2) showed better survival than those without dilatation (HR 8.63, p = 0.001). Conclusions In patients with severe AS treated with balloon-expandable TAVI, the presence of PVL, but not pre-procedural AR, was a major predictor of adverse outcome. Preoperative LV dilatation seemed to offer some clinical advantages. © 2017 Elsevier B.V.
Original languageEnglish
Pages (from-to)52-60
Number of pages9
JournalInternational Journal of Cardiology
Volume233
Issue number4
DOIs
Publication statusPublished - 2017

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