Abstract 11239: Significance of Residual Paravalvular Aortic Regurgitation (PAR) after Transfemoral Aortic Valve Implantation (TAVI)
Background: Residual PAR after TAVI is common. However, systematic data on its severity and its clinical impact are sparse. We, therefore, thought to evaluate incidence, severity and outcome of residual PAR after TAVI.
Methods: We analyzed data from 167 consecutive TAVI patients treated with either the Medtronic-CoreValve (n=88) or the Edwards Sapien (n=79) bioprosthesis. PAR was graded angiographically according to the Sellers criteria at the end of the procedure. In addition, invasive hemodynamics post implantation (pressure difference: diastolic aortic pressure - LVEDP (ΔPDAP-LVEDP)) were analyzed.
Results: TAVI was technically successful in all patients with overall mortality rates of 9%, 13 % and 20% at 30 days, 6 months and 1 year, respectively. PAR was observed in 113 patients (67%) whereof 89 (78,8%) showing mild, 21 (18,6%) moderate and 3 (2,7%) severe PAR. Cardiovascular mortality at 30 days, 6 months and 1-year was significantly increased in patients with moderate/severe PAR compared to those with no/mild PAR (4,5 vs. 50,0%, 5,1 vs. 61 % and 6,9 vs. 71 %, respectively, p<0.05) (figure 1). Further analysis of intraprocedural invasive hemodynamics suggested a ΔpDAP-LVEDP of 18 mmHg as a predictor of early and late mortality (figure2).
Conclusion: Moderate to severe PAR after TAVI was observed in 21% of patients and associated with an increased cardiovascular mortality. Therefore relevant PAR after TAVI should not be tolerated and countermeasure (postdilatation, valve in valve implantation) should be considered, especially with a ΔpDAP-LVEDP < 18 mm Hg.
- © 2011 by American Heart Association, Inc.