Prevalence and severity of paravalvular regurgitation in the Artificial Valve Endocarditis Reduction Trial (AVERT) echocardiography study.
OBJECTIVE
The purpose of this study was to determine the prevalence and severity of paravalvular regurgitation (PVR) in the Artificial Valve Endocarditis Reduction Trial (AVERT) cohort.


BACKGROUND
The initial AVERT cohort consisted of 807 patients randomized to receive either a Silzone-coated prosthetic valve or a conventional prosthetic valve; early clinical reports showed higher rates of valve explant caused by PVR for Silzone-coated prosthetic valve.


METHODS
Of the 678 eligible patients, 575 (85%) underwent postoperative transthoracic echocardiograms. The presence and severity of PVR were identified by color flow Doppler. Reviewers were blinded to the type of prosthetic valve and the demographic and clinical variables.


RESULTS
Among those who underwent echocardiography (Silzone-coated prosthetic valve, n = 285 and conventional prosthetic valve, n = 290), 59% had prosthetic aortic valves, 32% prosthetic mitral valves, and 9% had both; demographic and clinical findings (i.e., prosthetic valve endocarditis, thromboembolism, bleeding, and all-cause death) were similar for the two groups. Echocardiographically determined PVR was present in 50 valves: Silzone-coated prosthetic valve, 29 of 285 (10%) and conventional prosthetic valve, 21 of 290 (7%, p = NS); the severity of PVR was similar in both groups. Kaplan-Meier analysis showed no significant differences in PVR at 24 months from valve implantation between the two groups (24-month event-free rate: 93% Silzone-coated prosthetic valve vs. 94% conventional prosthetic valve, p = NS).


CONCLUSIONS
Excluding those patients who had initial prosthetic valve explant, the two-year echocardiographic follow-up of the AVERT cohort shows no statistically significant differences in the prevalence or severity of PVR in the Silzone-coated prosthetic valve compared with the conventional prosthetic valve. Further monitoring is warranted to determine whether these clinical outcomes remain similar on long-term follow-up.
AVERT Echocardiography Core Laboratory and the Cardiovascular Imaging and Clinical Research Core Laboratory, Cardiovascular Division, Washington University School of Medicine, St. Louis, Missouri 63110, USA. vdavila@im.wustl.edu <vdavila@im.wustl.edu>
Victor G
VG
Dávila-Román
Alan D
AD
Waggoner
Elizabeth D
ED
Kennard
Richard
R
Holubkov
W R Eric
WR
Jamieson
Lars
L
Englberger
Thierry P
TP
Carrel
Hartzell V
HV
Schaff
D000368:Aged; D001022:Aortic Valve Insufficiency / Q000000981:diagnostic imaging* / Q000453:epidemiology* / Q000209:etiology; D020099:Coated Materials, Biocompatible / Q000627:therapeutic use; D004452:Echocardiography; D018618:Echocardiography, Doppler, Color; D004696:Endocarditis / Q000150:complications* / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control; D005060:Europe; D005260:Female; D006350:Heart Valve Prosthesis / Q000009:adverse effects*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D008944:Mitral Valve Insufficiency / Q000000981:diagnostic imaging* / Q000453:epidemiology* / Q000209:etiology; D015337:Multicenter Studies as Topic; D009656:North America; D015995:Prevalence; D016459:Prosthesis-Related Infections / Q000150:complications* / Q000000981:diagnostic imaging / Q000209:etiology / Q000517:prevention & control; D016032:Randomized Controlled Trials as Topic; D012720:Severity of Illness Index; D012834:Silver / Q000627:therapeutic use
D020099:Coated Materials, Biocompatible; D012834:Silver