Incidence, predictors, and outcomes of aortic regurgitation after transcatheter aortic valve replacement

Meta-analysis and systematic review of literature

Ganesh Athappan, Eshan Patvardhan, E. Murat Tuzcu, Lars Georg Svensson, Pedro A. Lemos, Chiara Fraccaro, Giuseppe Tarantini, Jan Malte Sinning, Georg Nickenig, Davide Capodanno, Corrado Tamburino, Azeem Latib, Antonio Colombo, Samir R. Kapadia

Research output: Contribution to journalArticle

433 Citations (Scopus)

Abstract

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.

Original languageEnglish
Pages (from-to)1585-1595
Number of pages11
JournalJournal of the American College of Cardiology
Volume61
Issue number15
DOIs
Publication statusPublished - Apr 16 2013

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Aortic Valve Insufficiency
Meta-Analysis
Incidence
Confidence Intervals
Mortality
Transcatheter Aortic Valve Replacement
Luxembourg
Switzerland
Odds Ratio

Keywords

  • CoreValve
  • mild AR
  • post-TAVR AR
  • predictors of AR post-TAVR
  • TAVI

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Incidence, predictors, and outcomes of aortic regurgitation after transcatheter aortic valve replacement : Meta-analysis and systematic review of literature. / Athappan, Ganesh; Patvardhan, Eshan; Tuzcu, E. Murat; Svensson, Lars Georg; Lemos, Pedro A.; Fraccaro, Chiara; Tarantini, Giuseppe; Sinning, Jan Malte; Nickenig, Georg; Capodanno, Davide; Tamburino, Corrado; Latib, Azeem; Colombo, Antonio; Kapadia, Samir R.

In: Journal of the American College of Cardiology, Vol. 61, No. 15, 16.04.2013, p. 1585-1595.

Research output: Contribution to journalArticle

Athappan, G, Patvardhan, E, Tuzcu, EM, Svensson, LG, Lemos, PA, Fraccaro, C, Tarantini, G, Sinning, JM, Nickenig, G, Capodanno, D, Tamburino, C, Latib, A, Colombo, A & Kapadia, SR 2013, 'Incidence, predictors, and outcomes of aortic regurgitation after transcatheter aortic valve replacement: Meta-analysis and systematic review of literature', Journal of the American College of Cardiology, vol. 61, no. 15, pp. 1585-1595. https://doi.org/10.1016/j.jacc.2013.01.047
Athappan, Ganesh ; Patvardhan, Eshan ; Tuzcu, E. Murat ; Svensson, Lars Georg ; Lemos, Pedro A. ; Fraccaro, Chiara ; Tarantini, Giuseppe ; Sinning, Jan Malte ; Nickenig, Georg ; Capodanno, Davide ; Tamburino, Corrado ; Latib, Azeem ; Colombo, Antonio ; Kapadia, Samir R. / Incidence, predictors, and outcomes of aortic regurgitation after transcatheter aortic valve replacement : Meta-analysis and systematic review of literature. In: Journal of the American College of Cardiology. 2013 ; Vol. 61, No. 15. pp. 1585-1595.
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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.

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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.

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