Author + information
- Jan–Malte Sinning,
- Mariuca Vasa–Nicotera,
- Christoph Hammerstingl,
- Alexander Ghanem,
- Alexander Sedaghat,
- Eberhard Grube,
- Georg Nickenig and
- Nikos Werner
Since precise quantification of paravalvular aortic regurgitation (PAR) following transcatheter aortic valve replacement (TAVR) remains challenging especially in the acute implantation situation, a multi–modal approach is imperative to identify patients who will benefit from post–dilation or valve–in–valve implantation.
The Aortic Regurgitation (AR) Index has been introduced recently with a cut–off value of 25 as best predictor for both more–than–mild PAR and 1–year all–cause mortality. The AR Index was evaluated prospectively as part of a multimodal algorithm (see figure) to manage PAR after TAVR in a cohort of 145 patients and compared to a retrospective cohort (N=146).
Based on the AR Index, the occurrence of more–than–mild PAR in this prospective cohort could be reduced significantly compared to the retrospective cohort (6.9% vs. 15.1%; p=0.026), whereas the post–dilation rate was not significantly different (35.2% vs. 27.4%; p=0.15). By use of post–dilation, the AR Index could be increased from 17.8 ± 5.0 to 27.6 ± 7.5 (p<0.001) in 50/145 patients with significant PAR without excess of stroke risk (2.0% vs. 1.1%; p=0.65). The 30–day mortality rate showed a benefical trend in favor of the prospective cohort (3.4% vs. 6.8%; p=0.19).
A multimodal algorithm considering hemodynamics in addition to imaging modalities was useful to identify patients with significant PAR after TAVR and helped to reduce the procedure–related rate of paravalvular leakage.
West, Room 2002
Monday, March 11, 2013, 9:00 a.m.–9:10 a.m.
Session Title: Transcatheter Aortic Valve Replacement (TAVR) II: Complications
Abstract Category: 49. TCT@ACC–i2: Aortic Valve Disease
Presentation Number: 2911–9
- 2013 American College of Cardiology Foundation