Update on the clinical impact of mild aortic regurgitation after transcatheter aortic valve implantation: Insights from the Japanese multicenter OCEAN‐TAVI registry

Abstract

ObjectivesThis study aimed to compare the clinical impact of mild postprocedural aortic regurgitation (post‐AR) to that of none‐trivial post‐AR after transcatheter aortic valve implantation (TAVI) and to identify the vulnerability factors to mild post‐AR.BackgroundModerate–severe post‐AR, associated with increased mortality, is an important issue. However, the clinical impact of mild post‐AR remains controversial.Methods and resultsWe analyzed data from 1,572 consecutive patients (1,026 of none‐trivial post‐AR and 546 of mild post‐AR) obtained from the Optimized transCathEter vAlvular Intervention (OCEAN‐TAVI) Japanese multicenter registry. We evaluated the 1‐year cumulative cardiovascular death and re‐hospitalization rates for heart failure (HF) after TAVI according to the degree of post‐AR. Kaplan–Meier curves showed no significant difference between “none‐trivial post‐AR” and “mild post‐AR” in terms of cardiovascular death, but a significant difference was noted in the cumulative incidence of re‐hospitalization for HF between the two groups (hazard ratio 1.57, 95% confidence interval 1.02–2.41, p = .04). In the stratified analysis, only in patients with not more than 50% of left ventricular ejection fraction (LVEF), concentric left ventricular hypertrophy (LVH), and none‐trivial pre‐procedural aortic regurgitation (pre‐AR), mild post‐AR resulted in a higher incidence of re‐hospitalization for HF.ConclusionsIn this study, the clinical impact of mild post‐AR compared to none‐trivial post‐AR tended to be augmented in the presence of reduced LVEF, concentric LVH, and none‐trivial pre‐AR. Pre‐procedure echocardiographic findings including LVEF, left ventricular geometry, and pre‐AR may help to judge the necessity of postdilatation in case of mild post‐AR just after the bioprosthesis deployment.

Transcatheter aortic valve replacement with Evolut R versus Sapien 3 in Japanese patients with a small aortic annulus: The OCEAN‐TAVI registry

“…Recently, some studies demonstrated that even mild AR is considered an adverse prognostic indicator. 23,24 This finding could be an important factor in selecting devices for patients with a small aortic annulus.…”

“…Conversely, the AR after TAVR was controlled trivial or less in the Sapien 3 group than in the Evolut R (50.8 vs. 63.2%), because of the outer skirt to reduce AR and higher radial force that enhances the sealing of the valve into the native annulus. Recently, some studies demonstrated that even mild AR is considered an adverse prognostic indicator 23,24 . This finding could be an important factor in selecting devices for patients with a small aortic annulus.…”

Transcatheter aortic valve implantation: Do leaks matter?

“…This applies to patients whose primary indication for surgery is severe aortic stenosis. However, the study by Yoshijima et al, likewise shows the importance of postoperative AR as compared to preoperative AR as an important predictor of outcomes.…”

“…Yoshijima et al studied 1,572 patients who were enrolled in the Optimized transCathEter vAlvular Intervention (OCEAN‐TAVI) registry from 2013 to 2016, which involved 14 collaborating hospitals in Japan. The prospective OCEAN‐TAVI trial compared the Sapien XT/S3 (Edwards Lifesciences, Irvine, California) and the Medtronic CoreValve System (Medtronic, Minneapolis, Minnesota) for the treatment of severe aortic stenosis.…”

Should Transcatheter Aortic Valve Implantation Be the First-Choice Treatment? An Important Step Forward

“…8 In addition, the importance of decreasing PVL after TAVI, even in a contemporary TAVI cohort, to reduce the incidence of rehospitalization due to heart failure has been demonstrated. 9 The latest version of TAVI devices, meticulous screening, and procedural modification may improve clinical outcomes. It is also important to understand that "low risk" does not necessarily means "young age".…”