Author + information
- Eric Van Belle,
- Francis Juthier,
- André Vincentelli,
- Bernard lung,
- Helene Eltchaninoff,
- alain Leguerrier,
- Jean Fajadet,
- Marc Laskar,
- Carlo Banfi and
- Alain Prat
A significant peri–valvular aortic regurgitation (AR) is observed in 10–20 after a successful TAVR procedure. The prognostic value and the specific procedural predictors of such complication in Balloon–expendable (BE) and Self–expendable (SE) TAVR procedures remain unclear
2,769 patients consecutive with a successful procedure and a predischarge transthoracic echocardiography (TTE) were enrolled in 33 centers. Mean follow–up was 302±164 days.
Mean age was 83±7 years; 49% were female and logistic EuroSCORE was 21.5±13.8. BE and SE devices was implanted in 67.6% (n=1872) and 32.4% (n=897), respectively. Approaches were femoral (75.4%) or non femoral (24.6%). Post–procedural TTE showed a perivalvular AR≥2 in 14.9% of cases. Its occurrence was 2 fold higher in SE (19.8%) than in BE–TAVR procedures (12.2%, p=0.0001). This remained significant in multivariate analysis (adjusted HR=2.01, p=0.0001). A perivalvular AR≥2 was associated with a mortality at 1 year (24.2%) twice higher than in patients without AR (11.9%) (p=0.0001). This figure was similar for BE (27.1% vs 12.0%) and SE–TAVR (20.5% vs 11.8%) procedures By multivariate analysis, a perivalvular AR≥2 was the strongest predictor of 1 year mortality (ad. HR=2.35 [1.75–3.15]; p=0.0001). This figure was similar for BE (ad. HR=2.68) and SE–TAVR (ad. HR=2.10) procedures. For BE–TAVI procedures, a larger aortic annulus (ad. HR=1.09 for 1 mm increase, p=0.001), a smaller device diameter (ad. HR=2.38 for 3 mm decrease, p=0.0001) and a femoral approach (ad. HR=1.70, p=0.006) were the 3 major independent procedural predictors of peri–valvular AR≥2. For SE–TAVI procedures, femoral approach (ad.HR=2.10, p=0.008) was the only independent predictors of AR≥2. Importantly, device diameter and aortic annulus diameter were not a predictor of AR for SE–TAVR procedures.
Post–procedural perivalvular AR≥2 was observed in 15% of successful TAVI procedures and was the strongest and independent predictor of 1–year mortality for both BE and SE–TAVR procedures. Analysis of procedural predictors of AR suggests that device type and specific procedural characteristics may impact the occurrence of AR.
West, Room 2002
Monday, March 11, 2013, 8:45 a.m.–8:55 a.m.
Session Title: Transcatheter Aortic Valve Replacement (TAVR) II: Complications
Abstract Category: 49. TCT@ACC–i2: Aortic Valve Disease
Presentation Number: 2911–7
- 2013 American College of Cardiology Foundation