Abstract 17813: Post-dilatation and Procedural Outcomes in the PARTNER I Trial
Background: Compared to surgical aortic valve replacement, there is a higher incidence of paravalvular regurgitation following transcatheter aortic valve replacement (TAVR). Post-implant dilatation (PD) has been used to treat this potentially morbid complication. The objective of this study is to characterize the patients receiving PD and evaluate procedural outcomes.
Methods: The PARTNER-I trial Cohort A (n= 304) and Cohort B (n= 194) pts randomized to TAVR and the non-randomized continued access TAVR (n=1637) pts, were included in the analysis.
Results: The overall incidence of PD was 12.4%. PD pts were more likely to be male (p < 0.0001); have larger BSA (p < 0.0001); receive a 26 mm valve (p < 0.0001); have a history of smoking (p < 0.0001), CAD (p = 0.05), coronary bypass surgery (p = 0.002), pulmonary hypertension (p = 0.03) and major arrhythmias (p = 0.02). On echo, there was no significant difference in baseline mean gradient (p = 0.44) or indexed effective orifice area (iEOA) (p = 0.14), however PD pts had larger left ventricular (LV) dimensions and volumes (p < 0.01), greater LV mass (p < 0.0001), worse LV ejection fraction (p < 0.01), and larger annular diameter (p < 0.0001). There was no significant association with PD and 30 day adjudicated events (Table 1) including stroke, death (all-cause or cardiovascular), death or re-hospitalization, and death or major stroke.
Conclusion: There is no association between PD and procedural stroke or death. Intra-procedural PD can be safely performed to treat significant paravalvular regurgitation during TAVR.
- © 2013 by American Heart Association, Inc.