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

Andrea Colli, Laura Besola, Stefano Salizzoni, Dario Gregori, Giuseppe Tarantini, Marco Agrifoglio, Alaide Chieffo, Tommaso Regesta, Davide Gabbieri, Francesco Saia, Corrado Tamburino, Flavio Ribichini, Orazio Valsecchi, Bruno Loi, Alessandro Iadanza, Miroslava Stolcova, Alessandro Minati, Gianluca Martinelli, Francesco Bedogni, Anna PetronioMichele Dallago, Antioco Cappai, Augusto D'Onofrio, Gino Gerosa, Mauro Rinaldi

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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.
Original languageUndefined/Unknown
Pages (from-to)52-60
Number of pages9
JournalInternational Journal of Cardiology
Volume233
DOIs
Publication statusPublished - Apr 1 2017

Keywords

  • Aortic valve regurgitation, Aortic valve stenosis, Paravalvular leakage, TAVI, TAVR

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