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Device-dependent association between paravalvar aortic regurgitation and outcome after TAVI
  1. Rafal Dworakowski1,
  2. Olaf Wendler1,
  3. Brian Halliday1,
  4. Peter Ludman2,
  5. Mark DeBelder3,
  6. Simon Ray4,
  7. Neil Moat5,
  8. Jan Kovac6,
  9. Tomasz Spyt6,
  10. Uday Trivedi7,
  11. David Hildick-Smith7,
  12. Dan Blackman8,
  13. Damian Marlee9,
  14. David Cunningham9,
  15. Philip A MacCarthy1
  1. 1Kings College Hospital, London, UK
  2. 2University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
  3. 3James Cook University Hospital, Middlesbrough, UK
  4. 4University Hospital of South Manchester, UK
  5. 5Royal Brompton and Harefield Hospital, London, UK
  6. 6University Hospitals Leicester NHS Trust, Leicester, UK
  7. 7Sussex Cardiac Centre, Brighton and Sussex University Hospitals, Brighton, UK
  8. 8Leeds General Infirmary, Leeds, UK
  9. 9National Institute for Cardiovascular Outcome Research, UCL, London, UK
  1. Correspondence to Dr Philip MacCarthy, King's College Hospital, Denmark Hill, London SE5 9RS, UK; philip.maccarthy{at}nhs.net

Abstract

Objective The aim of the current study was to identify predictors of paraprosthetic aortic regurgitation (AR) after transcatheter aortic valve implantation (TAVI) and examine its influence on short/medium-term mortality using the UK TAVI Registry. TAVI is an effective treatment for high-risk patients with severe symptomatic aortic stenosis (AS), but paraprosthetic AR has been associated with increased in-hospital and mid-term mortality.

Methods Between January 2007 and December 2011, 2584 TAVI procedures were performed in the UK. Patients undergoing ‘valve-in-valve’ procedures, patients with aortic regurgitation as the primary pathology and with no recorded severity of AR were excluded from this analysis (n=144). In total, therefore, 2440 patients were included. Balloon-expandable and self-expanding devices were implanted in 52.7 and 47.2%, respectively, using either transfemoral (67.7%) or non-transfemoral, surgical access (32.3%).

Results Postprocedural AR was observed in 68%, mild AR in 57% and moderate-severe in 10%. A large aortic annulus, high preprocedural transaortic gradient, and use of self-expanding valve were independent predictors of moderate-severe AR. Moderate-severe (but not mild) AR was associated with increased mortality, and this relationship appeared significant for the balloon-expandable but not the self-expanding device.

Conclusions Our data suggest that a large aortic annulus, high preprocedural transaortic gradient, and use of the self-expanding valve predict moderate-severe AR after TAVI. Such a degree of AR is associated with a significantly worse outcome with the balloon-expandable, but not with the self-expanding valve. Further studies are needed to verify this and explore potential mechanisms.

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