Author + information
- Received September 9, 2012
- Revision received January 14, 2013
- Accepted January 15, 2013
- Published online April 16, 2013.
- Ganesh Athappan, MD⁎,†,
- Eshan Patvardhan, MD⁎,
- E. Murat Tuzcu, MD⁎,
- Lars Georg Svensson, MD, PhD‡,
- Pedro A. Lemos, MD§,
- Chiara Fraccaro, MD, PhD‖,
- Giuseppe Tarantini, MD, PhD‖,
- Jan-Malte Sinning, MD‖,
- Georg Nickenig, MD¶,
- Davide Capodanno, MD, PhD#,
- Corrado Tamburino, MD, PhD#,
- Azeem Latib, MD⁎⁎,
- Antonio Colombo, MD⁎⁎ and
- Samir R. Kapadia, MD⁎,⁎ ()
- ↵⁎Reprint requests and correspondence:
Dr. Samir R. Kapadia, Cardiac Catheterization Laboratory, Cleveland Clinic, 9500 Euclid Avenue, J2-3, Cleveland, Ohio 44195
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.
Dr. Latib is a member of the Medtronic advisory board. All other authors have reported that they have no relationship relevant to the contents of this paper to disclose.
- Received September 9, 2012.
- Revision received January 14, 2013.
- Accepted January 15, 2013.
- American College of Cardiology Foundation