TY - JOUR
T1 - Does pre-existing aortic regurgitation protect from death in patients who develop paravalvular leak after TAVI?
AU - Colli, Andrea
AU - Besola, Laura
AU - Salizzoni, Stefano
AU - Gregori, Dario
AU - Tarantini, Giuseppe
AU - Agrifoglio, Marco
AU - Chieffo, Alaide
AU - Regesta, Tommaso
AU - Gabbieri, Davide
AU - Saia, Francesco
AU - Tamburino, Corrado
AU - Ribichini, Flavio
AU - Valsecchi, Orazio
AU - Loi, Bruno
AU - Iadanza, Alessandro
AU - Stolcova, Miroslava
AU - Minati, Alessandro
AU - Martinelli, Gianluca
AU - Bedogni, Francesco
AU - Petronio, Anna
AU - Dallago, Michele
AU - Cappai, Antioco
AU - D'Onofrio, Augusto
AU - Gerosa, Gino
AU - Rinaldi, Mauro
PY - 2017/4/15
Y1 - 2017/4/15
N2 - 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 < 0.001 for PVL ≥ moderate and OR 1.04, p = 0.97 respectively). Patients with moderate–severe PVL and preoperative left ventricle (LV) dilatation (LVEDVi > 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.
AB - 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 < 0.001 for PVL ≥ moderate and OR 1.04, p = 0.97 respectively). Patients with moderate–severe PVL and preoperative left ventricle (LV) dilatation (LVEDVi > 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.
KW - Aortic valve regurgitation
KW - Aortic valve stenosis
KW - Paravalvular leakage
KW - TAVI
KW - TAVR
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U2 - 10.1016/j.ijcard.2017.02.005
DO - 10.1016/j.ijcard.2017.02.005
M3 - Article
C2 - 28188002
AN - SCOPUS:85011546074
VL - 233
SP - 52
EP - 60
JO - International Journal of Cardiology
JF - International Journal of Cardiology
SN - 0167-5273
ER -