Author + information
- Robert C. Stoler,
- Jae K. Oh,
- Michael Reardon,
- David Adams,
- Jeffrey Popma,
- Chad Kliger,
- Derek Brinster and
- Paul Grayburn
Background: Aortic regurgitation (AR) after TAVR is commonly due to PVL and has been associated with an adverse prognosis. A prevailing hypothesis is that the typically small, hypertrophied LV in AS does not tolerate AR, as does the more compliant LV in chronic severe AR. We hypothesized pre-existing AR would condition the LV, so that baseline AR would be protective in TAVR pts.
Methods: We compared mortality in 739 pts with baseline AR data who underwent attempted TAVR or surgical AVR in the CoreValve US Pivotal High Risk Trial. Pts were grouped by the presence or absence of ≥ mild AR at baseline. Groups were clinically similar in baseline characteristics. Survival was also compared by Cox proportional hazard adjusted for age >85y, STS >7%, home O2, albumin <3.3 g/dL, and SCr >2.0 mg/dL.
Results: After TAVR, there were significant differences in mortality between the none/trace AR vs ≥mild AR groups at 1y (p=0.008), but not at 3y (Figure), which remained after covariate adjustment. After SAVR, ≥mild AR had a protective effect on mortality at both time points. After adjustment, this difference remained significant at 1y (p=0.009) and 3y in the SAVR group. These finding could not explained by differences in LV dimensions, LV mass index, LVEF, aortic annulus size, or Doppler parameters of AS severity between SAVR pts with none/trace vs ≥mild AR at baseline.
Conclusions: Baseline AR was protective in TAVR and SAVR pts at 1 yr. To our knowledge, this is the first study to demonstrate a protective effect of baseline AR in SAVR pts.
Room 204 A
Sunday, March 19, 2017, 8:51 a.m.-9:01 a.m.
Session Title: Highlighted Original Research: Valvular Heart Disease and the Year in Review
Abstract Category: 37. Valvular Heart Disease: Therapy
Presentation Number: 912-10
- 2017 American College of Cardiology Foundation