Abstract 17550: Predictive Value and Predictors of Post-Procedural Peri-Valvular Aortic Regurgitation in Balloon-Expendable and Self-Expendable TAVI Procedures: Insights from the FRANCE2 Registry
Background: A significant peri-valvular aortic regurgitation (AR) is observed in 10-20% after a successful TAVI procedure. The prognostic value and the predictors of such complication in Balloon-expendable (BE) and Self-expendable (SE) TAVI procedures remain unclear.
Methods: 2,769 patients consecutive with a successful procedure and a predischarge transthoracic echocardiography (TTE) were enrolled in 33 centers. Mean follow-up was 302±164 days.
Results: Mean age was 83±7 years; 49% were female and logistic EuroSCORE was 21.5±13.8. BE and SE devices was implanted in 67.6% (n=1872) and 32.4% (n=897), respectively. Approaches were femoral (75.4%) or non femoral: subclavian (5.6%), transapical (17.2%) or trans-aortic (1.8%). Post-procedural TTE showed a perivalvular AR≥2 in 14.9% of cases. Its occurrence was 2 fold higher in SE (19.8%) than in BE-TAVI procedures (12.2%, p=0.0001). This remained significant in multivariate analysis (adjusted HR=2.01, p=0.0001). A perivalvular AR≥2 was associated with a mortality at 1 year (24.2%) twice higher than in patients without AR (11.9%) (p=0.0001). This figure was similar for BE (27.1% vs 12.0%) and SE-TAVI (20.5% vs 11.8%) procedures By multivariate analysis, a perivalvular AR≥2 was the strongest predictor of 1 year mortality (ad. HR=2.35 [1.75-3.15]; p=0.0001). This figure was similar for BE (ad. HR=2.68) and SE-TAVI (ad. HR=2.10) procedures. For BE-TAVI procedures, male gender (ad. HR=1.66, p=0.001), a device diameter/aortic annulus diameter Ratio <1.1 (ad. HR=1.83, p=0.0001) and a femoral approach (ad. HR=1.70, p=0.006) were the 3 major independent predictors of peri-valvular AR≥2. For SE-TAVI procedures, male gender (ad. HR=1.61, p=0.01) and a femoral approach (ad.HR=2.1, p=0.008) were 2 independent predictors of AR≥2. Importantly, device diameter/aortic annulus diameter Ratio was not a predictor of AR for SE-TAVI procedures.
Conclusion: Post-procedural perivalvular AR≥2 was observed in 15% of successful TAVI procedures. Its occurrence doubled the 1-year mortality rate and was the strongest and independent predictor of 1-year mortality for both BE and SE-TAVI procedures. Analysis of predictors of AR suggests that device type and procedural characteristics may impact the occurrence of AR
- © 2012 by American Heart Association, Inc.