Abstract 12443: Perivalvular Aortic Regurgitation and Clinical Outcome after TAVI : Role of the Delivery Approach - Insights from the France 2 Registry
Background: Significant aortic regurgitation (AR) is observed in 15-20% post-TAVI. The potential interaction between delivery approach, AR and clinical outcome is ill defined. On one hand, non-femoral (NF) delivery approaches (transapical, subclavian) are associated with a better axial control of endoprosthesis delivery and thus may have the potential to decrease the risk of AR. On the other hand, NF approaches are usually restricted to the most severe patients in whom the clinical impact of AR is unclear.
Methods: 2,769 consecutive patients were enrolled in 33 centers with a successful procedure and a predischarge transthoracic echocardiography (TTE). A perivalvular AR grade ≥ 2 by TTE was considered significant.
Results: Mean age was 83±7 years; 49% were female. Balloon-expendable (BE) and Self-expendable (SE) devices had been implanted in 67.6% and 32.4% of patients. Approaches were Femoral in 75.4% or NF in 24.6% (subclavian (5.6%), transapical (17.2%) or trans-aortic (1.8%)). A higher Euroscore was observed in patients treated through a NF rather than a Femoral approach (23.9±14.8 vs 21.1±14.1, p=0.0001). Post-procedural TTE showed a peri-valvular AR ≥2 in 14.9% of cases. As compared to the Femoral approach, NF approaches were associated with a lower risk of perivalvular AR ≥2 for both BE (8.0% vs 13.9%, p=0.0005) and SE (10.7% vs 21.8%, p=0.001) devices. Multivariate analysis confirmed NF approach to be independently associated with a reduced risk of AR ≥2 (HR=0.44, [0.26-0.75], p<0.0001). Among patients without AR≥2, 1-year mortality was nearly identical whether treated through NF or Femoral approach (13.1%, vs 11.1%, p=NS). Among patients with AR≥2, 1-year mortality was two-fold higher in patients treated through NF compared to Femoral approach (42.7% vs 22.1%, p=0.01).
Conclusion: Our results demonstrate that a better axial control of device delivery allowed by NF approaches can reduce the risk of AR after TAVI. When implantation without AR≥2 can be achieved, long-term survival of patients treated via NF approaches is excellent. Finally, our results suggest that in high-grade severity patients treated via NF approaches, the incidence of peri-valvular AR is associated with a prohibitive mortality rate.
- © 2012 by American Heart Association, Inc.