Progression and Prognosis of Paravalvular Regurgitation After Transcatheter Aortic Valve Implantation

Abstract

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)

Implante Transcateter de Valva Aórtica: O Que já Aconteceu e o que Ainda está Por Vir

“…It is a fact that with the new TAVI prostheses, their incidence has decreased; besides, even when present, they tend to decrease over time. 5,20 However, its presence is relevant and has a negative impact on patient survival, even for cases considered as a mild regurgitation. [21][22][23][24][25] Furthermore, the need for pacemaker implantation, which occurs in approximately 17% of self-expandable TAVI prostheses compared to 6% of surgical prostheses, 26 impacts long-term medical costs and patient mortality after TAVI.…”

“…É fato que com as novas próteses TAVI sua incidência tem diminuído e, mesmo quando presentes, tendem a diminuir ao longo do tempo. 5 , 20 Entretanto, sua presença é relevante e apresenta impacto negativo na sobrevida dos pacientes, mesmo para casos considerados discretos. 21 - 25 Ainda, a necessidade de implante de marcapasso, que acontece em cerca de 17% nas próteses TAVI autoexpansíveis frente a 6% nas próteses cirúrgicas 26 impacta nos custos médicos em longo prazo e na mortalidade dos pacientes após TAVI.…”