Five-year outcomes of mild paravalvular regurgitation after transcatheter aortic valve implantation.

Okuno, Taishi; Tomii, Daijiro; Heg, Dik; Lanz, Jonas; Praz, Fabien; Stortecky, Stefan; Reineke, David; Windecker, Stephan; Pilgrim, Thomas (2022). Five-year outcomes of mild paravalvular regurgitation after transcatheter aortic valve implantation. EuroIntervention, 18(1), pp. 33-42. Europa Digital & Publishing 10.4244/EIJ-D-21-00784

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BACKGROUND

Mild paravalvular regurgitation (PVR) remains a frequent and underappreciated adverse event after transcatheter aortic valve implantation (TAVI) despite remarkable progress in device technology and implantation technique.

AIMS

This study sought to investigate the impact of mild PVR after TAVI on five-year clinical outcomes.

METHODS

In a prospective TAVI registry, PVR prior to discharge was retrospectively assessed in an echocardiographic core laboratory. Patients with ≥moderate PVR were excluded. Mild PVR was categorised into mild and mild-to-moderate PVR using a recently proposed unifying 5-class grading scheme.

RESULTS

A total of 1,128 patients undergoing TAVI between 2007 and 2015 were enrolled. Of these, 560 patients had mild PVR, including 433 with mild (5-class) PVR and 127 with mild-to-moderate PVR. Patients with mild PVR were older (83 years vs 82 years, p=0.013) and had a higher surgical risk compared to patients with none/trace PVR (STS-PROM: 6.49±4.68 vs 5.41±3.48, p<0.001). At five years, patients with mild PVR had a higher risk of mortality than those with none/trace PVR (54.6% vs 43.8%; HRadjusted 1.26, 95% CI: 1.06-1.50). When applying the 5-class grading scheme, only mild-to-moderate PVR was associated with an increased risk of mortality at five years (mild PVR: HRadjusted 1.19, 95% CI: 0.99-1.43, mild-to-moderate PVR: HRadjusted 1.56, 95% CI: 1.20-2.02). The effect of mild PVR on five-year mortality was consistent across major subgroups.

CONCLUSIONS

Mild PVR was associated with an increased risk of mortality at five years after TAVI. The detrimental effect was primarily driven by mild-to-moderate PVR using the 5-class grading scheme.

CLINICAL TRIAL REGISTRATION

https://www.clinicaltrials.gov. NCT01368250.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Pre-clinic Human Medicine > Department of Clinical Research (DCR)
04 Faculty of Medicine > Department of Cardiovascular Disorders (DHGE) > Clinic of Cardiology
04 Faculty of Medicine > Department of Cardiovascular Disorders (DHGE) > Clinic of Heart Surgery

UniBE Contributor:

Okuno, Taishi, Heg, Dierik Hans, Lanz, Jonas, Praz, Fabien Daniel, Stortecky, Stefan, Reineke, David Christian, Windecker, Stephan, Pilgrim, Thomas

Subjects:

600 Technology > 610 Medicine & health

ISSN:

1774-024X

Publisher:

Europa Digital & Publishing

Language:

English

Submitter:

Nadia Biscozzo

Date Deposited:

21 Jan 2022 06:56

Last Modified:

27 Feb 2024 14:28

Publisher DOI:

10.4244/EIJ-D-21-00784

PubMed ID:

34930717

BORIS DOI:

10.48350/163239

URI:

https://boris.unibe.ch/id/eprint/163239

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