Author + information
- Mahmoud Ali,
- Ratnasari Padang,
- Kevin Greason,
- Christopher Scott,
- Charanjit Rihal,
- Mackram Eleid,
- Patricia Pellikka,
- Vuyisile Nkomo and
- Sorin Pislaru
Background: Paravalvular leak (PVL) negatively impacts outcomes, but a direct comparison of its impact after transcatheter aortic valve replacement (TAVR) versus surgical replacement (SAVR) has not been previously reported. We reviewed our experience to better understand the impact of PVL on survival after TAVR and SAVR.
Method: All patients undergoing TAVR or SAVR at Mayo Clinic between 2008 and 2014 with any degree of PVL post procedure were retrospectively studied. Primary end point was overall survival, compared based on whether PVL occurs after TAVR or SAVR.
Results: There were 593 patients with PVL (374 TAVR, 219 SAVR); age 78±11 year, 64% male, mean follow up 3±2 years. PVL was trivial or mild in 247 with TAVR and 200 with SAVR. The estimated survival at 1, 3 and 5 year was 86%, 68% and 48%, respectively for the entire cohort. Presence of PVL was associated with worse outcome after TAVR compared to SAVR, even after adjusting for age, gender, STS score, and PVL severity (adjusted hazard ratio (HR) 1.7, p=0.006). The difference in outcome was confirmed by propensity matched analyses (n=113 in each group; Figure), most notable beyond 3rd follow up year. On multivariate analysis, ≥ moderate right ventricular dysfunction (HR 3.0), ≥ moderate mitral regurgitation (HR 2.1), TAVR (HR 1.9), pulmonary hypertension (HR 1.7), and renal dysfunction (HR 1.4) were predictive of worse outcome (p<0.05 for all).
Conclusions: At mid-term follow up, the presence of PVL is associated with worse survival following TAVR than after SAVR.
Poster Hall, Hall C
Saturday, March 18, 2017, 3:45 p.m.-4:30 p.m.
Session Title: Interventional Cardiology: TAVR 3
Abstract Category: 17. Interventional Cardiology: Aortic Valve Disease
Presentation Number: 1243-179
- 2017 American College of Cardiology Foundation