Impact of Post-Procedural Aortic Regurgitation on Mortality After Transcatheter Aortic Valve Implantation

Objectives The goal of the study was to clarify the impact of post-procedural aortic regurgitation (post-AR) grade 2/4 on clinical outcomes. Background Post-AR >2/4 is known to be associated with poor short-to midterm outcome after transcatheter aortic valve implantation (TAVI). Methods We compared clinical outcomes in 400 consecutive TAVI recipients according to post-AR grade: grade 0 or 1 (group 1 = 74.8%), grade 2 (group 2 = 22.2%), or grade 3 or 4 (group 3 = 3.0%). Results The mean age was similar in the 3 groups (83.4 +/- 6.1 years) as was the logistic EuroSCORE (22.5 +/- 11.4%, 24.5 +/- 11.6%, and 21.5 +/- 9.4%, p = 0.28) and annulus size (22.0 +/- 1.8, 22.2 +/- 2.1, and 22.5 +/- 2.1 mm, p = 0.53). The Edwards valve was most frequently used in group 1 compared with groups 2 and 3 (89.3%, 78.7%, and 83.3%, p = 0.03), and the implanted valve size was similar in all groups (25.6 +/- 2.0, 25.4 +/- 2.2, and 25.5 +/- 2.2 mm, respectively, p = 0.69). Post-dilation was required more frequently in group 3 (4.7%, 24.1%, and 50.0%, respectively, p < 0.01). Post-procedural increase in mitral regurgitation was in line with the post-AR grade (0.78 +/- 0.73, 1.22 +/- 0.80, and 1.89 +/- 0.78, respectively, p < 0.01). Despite the absence of difference in 30-day mortality, longer-term outcome was significantly poorer in patients with AR grade 2 than in those with AR grade 0 or 1 (log-rank p < 0.01), albeit better than in patients with AR grade 3 or 4 (p = 0.04), regardless of TAVI type and left ventricular function. Post-AR >= 2/4 was also identified as an independent predictor of mid-to long-term mortality (hazard ratio: 1.68, 95% confidence interval: 1.21 to 1.44, p < 0.01). Conclusions Post-AR grade 2/4 after TAVI is associated with worse outcome compared with grade 0 or 1. Careful valve selection and post-dilation when required to avoid post-AR grade 2 may contribute to improved clinical outcome after TAVI. (J Am Coll Cardiol Intv 2012;5:1247-56) (C) 2012 by the American College of Cardiology Foundation