Abstract 12656: The Impact of Periprosthetic Aortic Regurgitation on Outcome in Patients After Transcatheter Aortic Valve Implantation
Objective: To assess the impact of periprosthetic aortic regurgitation (periAR) on outcome after transcatheter aortic valve implantation (TAVI).
Background: It remains controversial whether periAR, which occurs more frequently after TAVI than after surgical aortic valve replacement, influences outcome of TAVI patients.
Methods: TAVI was performed with the 18-F CoreValve prosthesis in 127 consecutive patients. The occurrence and severity of periAR was evaluated angiographically, by measurement of the end-diastolic gradient between left ventricle and aorta, and determination of NT-proBNP an troponin I levels after TAVI.
Results: In a total of 127 patients (mean age 80.7±6.4 years, mean logistic EuroSCORE 29.9±18.0%), 59/127 (47%) showed no signs of periAR, 47/127 (37%) only mild periAR, and 21/127 (16%) moderate periAR after TAVI. The gradient between left ventricular end-diastolic pressure and aortic diastolic pressure decreased from 36.4±10.8mmHg in none periAR to 30.3±9.8mmHg in mild periAR and 22.6±10.9mmHg in moderate periAR (P<0.001). In addition, the NT-proBNP (P=0.026) and troponin I level (P=0.016) at 48 hours were significantly increased in patients with moderate periAR. 15% (9/59) of patients with none periAR, 30% (14/47) with mild periAR, and 62% (13/21) with moderate periAR died during the first year (P<0.001). The occurrence of periAR was associated with an increased risk for 30-day mortality (P=0.008) and 1-year mortality (P<0.001) after TAVI.
Conclusions: The occurrence of more than mild periAR is an independent predictor of 1-year mortality after TAVI. Every effort should be made to downgrade a significant periAR to avoid negative hemodynamic effects which are associated with an increased mortality.
- © 2011 by American Heart Association, Inc.