Author + information
- Dragos Alexandru,
- Timothy Park,
- Florentina Petillo,
- Simcha Pollack,
- George Petrossian,
- Newell Robinson,
- Dennis Mihalatos and
- Eddy Barasch
Background: Paravalvular regurgitation (PVR) after transarterial valve replacement (TAVR) is associated with adverse outcomes. We sought to examine the natural history of PVR after TAVR employing the recently proposed echocardiographic methods, and to compare these methods with the hemodynamic determination of PVR severity by aortic regurgitation index (ARI).
Methods: Between 2012-2015, 397 pts (age 83.9 ± 7.3 yrs, 50% males, BSA 1.8 ± 0.3 m2, EF 56.1 ± 14%) underwent commercially TAVR, 122 Edwards Sapiens (ES) and 275 Medtronic CoreValve systems (CVC). 90% had transfemoral access, median f/u, 33 days. The immediately post TAVR echo (echo 1) was compared with the last f/u echo in the database (echo 2). The semiquantitative evaluation of PVR was done according to the academic valve research consortium -2 recommendations. ARI = ([DBP – LVEDP]/SBP) × 100. A paired-t-test, ANOVA adjusted for demographics EF and valve type, and Pearson correlation were performed. Intra class correlation coefficient (ICC) was calculated in 20 pts.
Results: ICC was 0.92 and 0.93 for echo 1 and echo 2, respectively. Mean PVR at echo 1 and 2 was 7.5 ± 9.8% and 4.7 ± 8.9 %, respectively for ES (p=0.07) and 9.9 ± 10.3 at Echo 1 and 5.4 ± 8.2% at Echo 2, for CVC. (p<0.0001). For ES valve, severe PVR was found in 5% at echo 1 and 2, and for CVC, 4% at echo 1 and 1.4% at echo 2. For both valves, the association (r, (p-value)) between semiquantitative evaluation with other echo methods and qualitative evaluation was 0.57 (<0.0001) and 0.74 (<0.0001), respectively at echo 1 and 0.54 (<0.0001) and 0.68 (<0.0001) at echo 2. ARI = 28.9, 28.8 and 25.1 for trace/mild, moderate and severe PVR (p= 0.38). No association was found between ARI and PVR. At f/u, there was a significant decline in PVR severity for both valves (mean difference 4.1%, 95% CI, 2.7-5.5, p<0.0001). For CVC, 4.6%, 95% CI: 2.9-6.2 p<.0001, and for ES 2.9 % (p=0.07).
Conclusions: 1. After TAVR, PVR severity declines over time in both CVC and ES valves. 2. There was no association between echo semiquantitative PVR severity and invasive hemodynamic assessment (ARI) which did not discriminate between different degrees of regurgitation severity, for severe PVR, possible due to type II error.
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: 1243-178
- 2017 American College of Cardiology Foundation