TY - JOUR
T1 - Impact and natural history of postprocedural aortic regurgitation on early and midterm mortality following transcatheter aortic valve implantation in high-risk patients with severe aortic stenosis
AU - Ielasi, Alfonso
AU - Latib, Azeem
AU - Sacco, Francesco Maria
AU - Costopoulos, Charis
AU - Figini, Filippo
AU - Grimaldi, Antonio
AU - Naim, Charbel
AU - Maisano, Francesco
AU - Chieffo, Alaide
AU - Montorfano, Matteo
AU - Alfieri, Ottavio
AU - Colombo, Antonio
N1 - Publisher Copyright:
© 2015 Wolters Kluwer Health, Inc. All rights reserved.
PY - 2015/4/4
Y1 - 2015/4/4
N2 - Background Post-procedural aortic regurgitation (AR) negatively impacts the prognosis after trans-catheter aortic valve implantation. However, data evaluating the impact of different post-procedural AR grades (particularly mild) on clinical outcomes are still important. Aim and Methods A retrospective cohort analysis was performed on all consecutive patients with severe aortic stenosis who underwent trans-catheter aortic valve implantation between July 2008 and August 2011 in a single Institution. Aim of the study was to evaluate the impact of different post-procedural AR grades on early and mid-term clinical outcomes. Results 322 consecutive patients were evaluated. At post-procedural echocardiographic evaluation: 105 (32.6%) patients had no AR, 204 (63.4%) mild AR and 13 (4%) moderate/severe AR. In-hospital mortality was higher in patients with moderate/severe AR than in those with absent or mild AR (38.5% vs. 2.6%, P<0.001). At a median clinical follow-up of 342 days [interquartile range 93-485] cardiovascular mortality was 2.9% in patients without AR; 13.2% in the mild AR group (P=0.004 vs. absent AR) and 46.2% in the moderate/severe AR group (P<0.001 vs. mild or absent AR). On multivariable analysis, post-procedural AR (hazard ratio=2.65 absent vs. present any grade, 95% confidence interval=1.11-6.29; P=0.027) was an independent predictor of mid-term mortality. Conclusions The impact of post-procedural AR on outcomes after trans-catheter aortic valve implantation is proportional with its grade even in case of mild post-procedural AR compared to absent. This study confirms that every effort should be made to reduce the grade of post-procedural AR after trans-catheter aortic valve implantation with current devices.
AB - Background Post-procedural aortic regurgitation (AR) negatively impacts the prognosis after trans-catheter aortic valve implantation. However, data evaluating the impact of different post-procedural AR grades (particularly mild) on clinical outcomes are still important. Aim and Methods A retrospective cohort analysis was performed on all consecutive patients with severe aortic stenosis who underwent trans-catheter aortic valve implantation between July 2008 and August 2011 in a single Institution. Aim of the study was to evaluate the impact of different post-procedural AR grades on early and mid-term clinical outcomes. Results 322 consecutive patients were evaluated. At post-procedural echocardiographic evaluation: 105 (32.6%) patients had no AR, 204 (63.4%) mild AR and 13 (4%) moderate/severe AR. In-hospital mortality was higher in patients with moderate/severe AR than in those with absent or mild AR (38.5% vs. 2.6%, P<0.001). At a median clinical follow-up of 342 days [interquartile range 93-485] cardiovascular mortality was 2.9% in patients without AR; 13.2% in the mild AR group (P=0.004 vs. absent AR) and 46.2% in the moderate/severe AR group (P<0.001 vs. mild or absent AR). On multivariable analysis, post-procedural AR (hazard ratio=2.65 absent vs. present any grade, 95% confidence interval=1.11-6.29; P=0.027) was an independent predictor of mid-term mortality. Conclusions The impact of post-procedural AR on outcomes after trans-catheter aortic valve implantation is proportional with its grade even in case of mild post-procedural AR compared to absent. This study confirms that every effort should be made to reduce the grade of post-procedural AR after trans-catheter aortic valve implantation with current devices.
KW - aortic regurgitation
KW - aortic stenosis
KW - transcatheter aortic valve implantation
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U2 - 10.2459/JCM.0000000000000249
DO - 10.2459/JCM.0000000000000249
M3 - Article
C2 - 25643194
AN - SCOPUS:84926418985
SN - 1558-2027
VL - 16
SP - 286
EP - 295
JO - Journal of Cardiovascular Medicine
JF - Journal of Cardiovascular Medicine
IS - 4
ER -