Abstract 21129: Determinants and Outcome of Valvular Dysfunction Following Transcatheter Aortic Valve Implantation
Background: There is a paucity of data evaluating the determinants of valvular dysfunction of transcatheter aortic bioprostheses and the sequelae of such dysfunction. We sought to evaluate the predictors and clinical implications of transcatheter aortic valve dysfunction.
Methods: The study included consecutive patients with severe aortic stenosis(AS) treated by transcatheter aortic valve implantation(TAVI). Hemodynamic parameters of valvular dysfunction studied were significant aortic regurgitation(AR; grade 2 or more) and prosthesis-patient mismatch. Both predictors and clinical sequelae of valvular dysfunction were studied in univariate and multivariate regression models.
Results: A total of 209 patients were studied; 50 with a self expanding design and 159 with a balloon expandable design. Mean age was 83±7.3 years and mean logistic EuroSCORE 28.5±17.2. Prosthesis-patient mismatch was observed in 36.8% of patients but this was severe in only 5.7%. Only device positioning was a significant independent predictor of prosthesis-patient mismatch(for optimal positioning p=0.037, adjusted hazard ratio, HR, 0.455, 95% confidence interval, CI, 0.217–0.955). Prosthesis-patient mismatch was associated with a trend towards higher mortality (figure) but not changes in functional class. Post-procedure 7.7% had AR of grade 2 or more. Significant AR was predicted by patient corporeal dimensions, prosthesis undersizing and history of hypertension. Post TAVI AR of grade 2 or more was unrelated to failure to improve functional class; it was a significant independent predictor of thirty day mortality(p=0.007, adjusted HR 9.15, 95% CI 1.817–46.07).
Conclusions: Valvular dysfunction is a rare occurrence following transcatheter aortic valve implantation and may be influenced by patient-related and procedural factors. We demonstrate an important relationship of valvular dysfunction to thirty day mortality.
- © 2010 by American Heart Association, Inc.