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Aortic regurgitation after transcatheter aortic valve implantation: incidence and early outcome. Results from the German transcatheter aortic valve interventions registry
  1. Mohamed Abdel-Wahab1,
  2. Ralf Zahn2,
  3. Martin Horack3,
  4. Ulrich Gerckens4,
  5. Gerhard Schuler5,
  6. Horst Sievert6,
  7. Holger Eggebrecht7,
  8. Jochen Senges3,
  9. Gert Richardt1,
  10. for the German transcatheter aortic valve interventions registry investigators
  1. 1Heart Center, Segeberger Kliniken GmbH, Bad Segeberg, Germany
  2. 2Department of Cardiology, Clinical Center of Ludwigshafen, Ludwigshafen, Germany
  3. 3Institute of Myocardial Infarction Research at the University of Heidelberg, Ludwigshafen, Germany
  4. 4Department of Cardiology, HELIOS Hospital, Siegburg, Germany
  5. 5Heart Center, University of Leipzig, Leipzig, Germany
  6. 6Cardiovascular Center Frankfurt, Sankt Katharinen, Frankfurt am Main, Germany
  7. 7Clinic for Cardiology, West German Heart Center Essen, Essen, Germany
  1. Correspondence to Dr Mohamed Abdel-Wahab, Heart Center, Segeberger Kliniken GmbH, Academic Teaching Hospital of the University of Kiel, Am Kurpark 1, 23795 Bad Segeberg, Germany; mohamed.abdel-wahab{at}segebergerkliniken.de

Abstract

Background Significant aortic regurgitation (AR) is rare following surgical aortic valve replacement and has been associated with worse outcome. Following transcatheter aortic valve implantation (TAVI), AR is common, but little is known about its determinants and its effect on clinical outcome.

Objective To evaluate early outcome and risk factors possibly associated with AR after TAVI.

Methods Data were analysed from 690 patients with severe aortic stenosis treated with TAVI enrolled in the prospective multicentre German transcatheter aortic valve interventions registry. The occurrence of AR was evaluated angiographically after device deployment and removal of the catheter and guidewire. Significant AR was defined as AR≥2/4.

Results The study population's mean age was 81.4±6.3 years and men represented 44%. The mean logistic Euroscore was 20.4±13.1%. Overall, 84% of patients received the Medtronic CoreValve system and 16% received the Edwards Sapien valve. Significant AR occurred in 119 patients (17.2%). Factors independently associated with significant AR were aortic valve area (adjusted OR=0.10), annulus measurement by transoesophageal echocardiography (adjusted OR=1.94), male gender (adjusted OR=1.80), cardiogenic shock (adjusted OR=1.94) and renal failure (adjusted OR=0.53). In-hospital death rates were significantly higher in patients with significant AR than in those with no/mild AR (15.1% vs 6.7%, OR=2.50, 95% CI 1.37 to 4.55), as were rates of low cardiac output (20% vs 4.4%) and respiratory failure (16.5% vs 7.1%). Using multivariate analysis, the presence of post-procedural AR≥2/4 remained a strong independent predictor of in-hospital death (adjusted OR=2.43, 95% CI 1.22 to 4.85).

Conclusion Significant AR after TAVI is common and is associated with increased in-hospital mortality. Long-term follow-up is critical to further define the impact of residual AR on clinical outcome. Until these data become available, every effort should be made to prevent and treat this complication.

  • Aortic regurgitation
  • transcatheter aortic valve implantation
  • outcome
  • percutaneous valve therapy
  • aortic valve disease
  • prosthetic heart valves

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Footnotes

  • Competing interests None.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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