Author + information
- Konstantinos Stathogiannis,
- Konstantinos Toutouzas,
- Maria Drakopoulou,
- Archontoula Michelongona,
- Andreas Synetos,
- George Latsios,
- George Trantalis,
- Odysseas Kaitozis,
- Constantina Aggeli,
- Eleftherios Tsiamis and
- Dimitris Tousoulis
Background: The significance of aortic regurgitation in patients with severe aortic stenosis is well known. The aim of this study was to investigate the impact of mixed aortic valve disease (MAVD) in patients undergoing transcatheter aortic valve replacement (TAVR) with a self-expanding valve.
Methods: Patients with severe and symptomatic aortic stenosis who were scheduled for TAVR were prospectively enrolled. Prospectively collected echocardiographic data before and after TAVR were retrospectively analyzed in all patients. Primary clinical end-point was 4-year all-cause mortality. All outcomes were evaluated according to the VARC-2 criteria. Patients with no aortic regurgitation (AR) were considered to have pure aortic stenosis (AS) and patients with mild/moderate/severe AR were considered to have MAVD.
Results: We included 176 patients (age: 80±8 years; logistic EuroSCORE 24±9%; 59% females; NYHA III 81%) in the study. Thirty-seven patients (21%) had pure AS and 139 patients had MAVD (79%). The primary clinical end point occurred in 8 patients with pure AS and in 33 patients with MAVD (22% versus 24% respectively, p=0.78). No major differences were observed concerning cardiovascular death (16% versus 13%, p=0.7) and stroke (5% versus 3%, p=0.15) in pure AS and MAVD patients respectively. Post TAVR paravalvular leakage (PVL) was higher in the MAVD group compared to the pure AS group (moderate PVL: 9% vs 7%, p<0.001) and none of the patients had severe PVL. Post TAVR balloon dilation was equal and non-significant between the 2 groups (11% vs 18% for pure AS and MAVD groups respectively, p=0.3). At multivariate analysis, severe AR pre TAVR (p<0.005, OR: 9, 95%CI: 1.922-42) was an independent predictor of long-term mortality.
Conclusions: Mixed aortic valve disease with severe aortic regurgitation before TAVR is associated with increased long-term mortality and further studies are needed in order to explore the optimal strategies for patient selection.
Poster Hall, Hall C
Saturday, March 18, 2017, 9:45 a.m.-10:30 a.m.
Session Title: Interventional Cardiology: TAVR 2
Abstract Category: 17. Interventional Cardiology: Aortic Valve Disease
Presentation Number: 1195-185
- 2017 American College of Cardiology Foundation