Prognostic significance of mild aortic regurgitation in predicting mortality after transcatheter aortic valve replacement

Jones, Brandon; Tuzcu, E. Murat; Krishnaswamy, Amar; Popović, Zoran B.; Mick, Stephanie; Roselli, Eric E.; Gul, Sajjad; Devgun, Jasneet; Mistry, Sohi; Jaber, Wael A.; Svensson, Lars; Kapadia, Samir

doi:10.1016/j.jtcvs.2016.05.023

Cited by 46 publications

(32 citation statements)

References 23 publications

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“…It appears that residual AR (most often caused by perivalvular leak) blocks a decrease in LVEDV post‐TAVR. Postprocedural AR is known as a significant prognostic factor after TAVR . Several studies conducted with early generation valves showed that even mild AR has an adverse impact on survival .…”

Section: Discussionmentioning

confidence: 99%

Reversibility of Cardiac Function Predicts Outcome After Transcatheter Aortic Valve Replacement in Patients With Severe Aortic Stenosis

Sato

Kumar

Jones

et al. 2017

JAHA

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BackgroundReversibility of left ventricular (LV) dysfunction in high‐risk aortic stenosis patient and its impact on survival after transcatheter aortic valve replacement (TAVR) are unclear. We aimed to evaluate longitudinal changes of LV structure and function after TAVR and their impact on survival.Methods and ResultsWe studied 209 patients with aortic stenosis who underwent TAVR from May 2006 to December 2012. Echocardiograms were used to calculate LV end‐diastolic volume index (LVEDVi), LV ejection fraction, LV mass index (LVMi), and global longitudinal strain before, immediately (<10 days), late (1–3 months), and yearly after TAVR. During a median follow‐up of 1345 days, 118 patients died, with 26 dying within 1 year. Global longitudinal strain, LVEDVi, LV ejection fraction, and LVMi improved during follow‐up. In patients who died during the first year, death was preceded by LVEDVi and LVMi increase. Multivariable longitudinal data analysis showed that aortic regurgitation at baseline, aortic regurgitation at 30 days, and initial LVEDVi were independent predictors of subsequent LVEDVi. In a joint analysis of longitudinal and survival data, baseline Society of Thoracic Surgeons score was predictive of survival, with no additive effect of longitudinal changes in LVEDVi, LVMi, global longitudinal strain, or LV ejection fraction. Presence of aortic regurgitation at 1 month after TAVR was the only predictor of 1‐year survival.Conclusions LV reverse remodeling was observed after TAVR, whereas lack of LVEDVi and LVMi improvement was observed in patients who died during the first year after TAVR. Post‐TAVR, aortic regurgitation blocks reverse remodeling and is associated with poor 1‐year survival after TAVR.

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Section: Discussionmentioning

confidence: 99%

Reversibility of Cardiac Function Predicts Outcome After Transcatheter Aortic Valve Replacement in Patients With Severe Aortic Stenosis

Sato

Kumar

Jones

et al. 2017

JAHA

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“…Our initial literature search resulted in total of 3,447 articles. A total of 25 articles [3,[6][7][8][9][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34] including total of 21,018 patients were finally included for quantitative synthesis (meta-analysis). Detailed study selection flow is summarized in Supporting Information 1.…”

Section: R Esu L Tsmentioning

confidence: 99%

Does mild paravalvular regurgitation post transcatheter aortic valve implantation affect survival? A meta‐analysis

Ando

Briasoulis

Telila

et al. 2017

Cathet Cardio Intervent

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“…Commercially available earlier-generation transcatheter valves, despite providing good clinical outcomes, were not free from shortcomings; indeed, high rates of conduction abnormalities, permanent pacemaker implantation (PPI) or vascular complications remained important issues to be addressed. More importantly, though, higher incidence of paravalvular leak (PVL), in turn associated with increased late mortality and higher rate of other adverse clinical incidents, as compared to SAVR [11][12][13], often outweigh the benefits of transcatheter approach.…”

Section: Introductionmentioning

confidence: 99%

Transcatheter Aortic Valve Replacement with Self-Expandable ACURATE neo as Compared to Balloon-Expandable SAPIEN 3 in Patients with Severe Aortic Stenosis: Meta-Analysis of Randomized and Propensity-Matched Studies

Gozdek

Zieliński

Pasierski

et al. 2020

JCM

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Frequent occurrence of paravalvular leak (PVL) after transcatheter aortic valve replacement (TAVR) was the main concern with earlier-generation devices. Current meta-analysis compared outcomes of TAVR with next-generation devices: ACURATE neo and SAPIEN 3. In random-effects meta-analysis, the pooled incidence rates of procedural, clinical and functional outcomes according to VARC-2 definitions were assessed. One randomized controlled trial and five observational studies including 2818 patients (ACURATE neo n = 1256 vs. SAPIEN 3 n = 1562) met inclusion criteria. ACURATE neo was associated with a 3.7-fold increase of moderate-to-severe PVL (RR (risk ratio): 3.70 (2.04–6.70); P < 0.0001), which was indirectly related to higher observed 30-day mortality with ACURATE valve (RR: 1.77 (1.03–3.04); P = 0.04). Major vascular complications, acute kidney injury, periprocedural myocardial infarction, stroke and serious bleeding events were similar between devices. ACURATE neo demonstrated lower transvalvular pressure gradients both at discharge (P < 0.00001) and at 30 days (P < 0.00001), along with lower risk of patient–prosthesis mismatch (RR: 0.29 (0.10–0.87); P = 0.03) and pacemaker implantation (RR: 0.64 (0.50–0.81); P = 0.0002), but no differences were observed regarding composite endpoints early safety and device success. In conclusion, ACURATE neo, as compared with SAPIEN 3, was associated with higher rates of moderate-to-severe PVL, which were indirectly linked with increased observed 30-day all-cause mortality.

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Prognostic significance of mild aortic regurgitation in predicting mortality after transcatheter aortic valve replacement

Abstract: Even mild aortic regurgitation after transcatheter aortic valve replacement is associated with worse long-term mortality. There may be prognostic value in reporting milder categories of aortic regurgitation with more granular gradations.

Cited by 46 publications

References 23 publications

Reversibility of Cardiac Function Predicts Outcome After Transcatheter Aortic Valve Replacement in Patients With Severe Aortic Stenosis

Reversibility of Cardiac Function Predicts Outcome After Transcatheter Aortic Valve Replacement in Patients With Severe Aortic Stenosis

Does mild paravalvular regurgitation post transcatheter aortic valve implantation affect survival? A meta‐analysis

Transcatheter Aortic Valve Replacement with Self-Expandable ACURATE neo as Compared to Balloon-Expandable SAPIEN 3 in Patients with Severe Aortic Stenosis: Meta-Analysis of Randomized and Propensity-Matched Studies

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