Progression and Prognosis of Paravalvular Regurgitation After Transcatheter Aortic Valve Implantation

• Published in: Arquivos brasileiros de cardiologia 2017-12, Vol.109 (6), p.0-0
• Main Authors: Meneguz-Moreno, Rafael Alexandre, Castro-Filho, Antônio de, Ramos, Auristela Isabel de Oliveira, Zumarraga, Mayra, Bihan, David Le, Barretto, Rodrigo, Siqueira, Dimytri Alexandre de Alvim, Abizaid, Alexandre Antonio Cunha, Sousa, Amanda Guerra de Moraes Rego, Sousa, J. Eduardo
• Format: Article
• Language: eng ; por
• Subjects: Aortic Valve Insufficiency / complications; CARDIAC & CARDIOVASCULAR SYSTEMS; Heart Valve Prosthesis Implantation; Mortality; Original; Prognosis
• ISSN: 0066-782X; 1678-4170; 1678-4170
• DOI: 10.5935/abc.20170172

BACKGROUNDThe impact of paravalvular regurgitation (PVR) following transcatheter aortic valve implantation (TAVI) remains uncertain.OBJECTIVETo evaluate the impact of PVR on mortality and hospital readmission one year after TAVI.METHODSBetween January 2009 and June 2015, a total of 251 patients underwent TAVI with three different prostheses at two cardiology centers. Patients were assessed according to PVR severity after the procedure.RESULTSPVR was classified as absent/trace or mild in 92.0% (n = 242) and moderate/severe in 7.1% (n = 18). The moderate/severe PVR group showed higher levels of aortic calcification (22% vs. 6%, p = 0.03), higher serum creatinine (1.5 ± 0.7 vs. 1.2 ± 0.4 mg/dL, p = 0.014), lower aortic valve area (0.6 ± 0.1 vs. 0.7 ± 0.2 cm2, p = 0.05), and lower left ventricular ejection fraction (49.2 ± 14.8% vs. 58.8 ± 12.1%, p = 0.009). Patients with moderate/severe PVR had more need for post-dilatation (p = 0.025) and use of larger-diameter balloons (p = 0.043). At one year, all-cause mortality was similar in both groups (16.7% vs. 12%, p = 0.08), as well as rehospitalization (11.1% vs. 7.3%, p = 0.915). PVR grade significantly reduced throughout the first year after the procedure (p < 0.01). The presence of moderate/severe PVR was not associated with higher one-year mortality rates (HR: 0.76, 95% CI: 0.27-2.13, p = 0.864), rehospitalization (HR: 1.08, 95% CI: 0.25-4.69, p=0.915), or composite outcome (HR: 0.77, 95% CI: 0.28-2.13, p = 0.613).CONCLUSIONIn this sample, moderate/severe PVR was not a predictor of long-term mortality or rehospitalization. (Arq Bras Cardiol. 2017; [online].ahead print, PP.0-0).