title: Aortic regurgitation after transcatheter aortic valve implantation: incidence and early outcome. Results from the German transcatheter aortic valve interventions registry.
abstract: BACKGROUND
  Significant aortic regurgitation (AR) is rare following surgical aortic valve replacement and has been associated with worse outcome. Following transcatheter aortic valve implantation (TAVI), AR is common, but little is known about its determinants and its effect on clinical outcome.
  
  
  OBJECTIVE
  To evaluate early outcome and risk factors possibly associated with AR after TAVI.
  
  
  METHODS
  Data were analysed from 690 patients with severe aortic stenosis treated with TAVI enrolled in the prospective multicentre German transcatheter aortic valve interventions registry. The occurrence of AR was evaluated angiographically after device deployment and removal of the catheter and guidewire. Significant AR was defined as AR≥2/4.
  
  
  RESULTS
  The study population's mean age was 81.4±6.3 years and men represented 44%. The mean logistic Euroscore was 20.4±13.1%. Overall, 84% of patients received the Medtronic CoreValve system and 16% received the Edwards Sapien valve. Significant AR occurred in 119 patients (17.2%). Factors independently associated with significant AR were aortic valve area (adjusted OR=0.10), annulus measurement by transoesophageal echocardiography (adjusted OR=1.94), male gender (adjusted OR=1.80), cardiogenic shock (adjusted OR=1.94) and renal failure (adjusted OR=0.53). In-hospital death rates were significantly higher in patients with significant AR than in those with no/mild AR (15.1% vs 6.7%, OR=2.50, 95% CI 1.37 to 4.55), as were rates of low cardiac output (20% vs 4.4%) and respiratory failure (16.5% vs 7.1%). Using multivariate analysis, the presence of post-procedural AR≥2/4 remained a strong independent predictor of in-hospital death (adjusted OR=2.43, 95% CI 1.22 to 4.85).
  
  
  CONCLUSIONS
  Significant AR after TAVI is common and is associated with increased in-hospital mortality. Long-term follow-up is critical to further define the impact of residual AR on clinical outcome. Until these data become available, every effort should be made to prevent and treat this complication.
authors.affiliation: Heart Center, Segeberger Kliniken GmbH, Bad Segeberg, Germany. mohamed.abdel-wahab@segebergerkliniken.de
authors.forename: Mohamed
authors.initials: M
authors.lastname: Abdel-Wahab
authors.forename: Ralf
authors.initials: R
authors.lastname: Zahn
authors.forename: Martin
authors.initials: M
authors.lastname: Horack
authors.forename: Ulrich
authors.initials: U
authors.lastname: Gerckens
authors.forename: Gerhard
authors.initials: G
authors.lastname: Schuler
authors.forename: Horst
authors.initials: H
authors.lastname: Sievert
authors.forename: Holger
authors.initials: H
authors.lastname: Eggebrecht
authors.forename: Jochen
authors.initials: J
authors.lastname: Senges
authors.forename: Gert
authors.initials: G
authors.lastname: Richardt
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001022:Aortic Valve Insufficiency / Q000209:etiology*; D001024:Aortic Valve Stenosis / Q000628:therapy*; D006328:Cardiac Catheterization / Q000009:adverse effects*; D002404:Catheterization / Q000009:adverse effects*; D005260:Female; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects*; D006760:Hospitalization; D006801:Humans; D008297:Male; D011379:Prognosis; D011446:Prospective Studies; D012042:Registries