title: Impact of residual regurgitation after aortic valve replacement.
abstract: OBJECTIVE
  Mild-to-moderate aortic regurgitation (AR) is not infrequently encountered after standard aortic valve replacement, and reportedly more often following transcatheter aortic valve implantation. Patients are usually managed by observational follow-up, but the clinical significance and natural history of residual AR are unknown. The goal of this study was to determine its impact on the outcome of these patients.
  
  
  METHODS
  Between 1992 and 2011, 3201 consecutive patients underwent isolated standard aortic valve replacement in our institution. Of these, 135 patients (4.2%) were found to have paravalvular leak >1/4. Clinical, intraoperative as well as early and late postoperative outcome variables were studied. Factors associated with residual AR and their impact on survival were assessed by multivariate analysis.
  
  
  RESULTS
  Mean follow-up was 4.5 ± 3.4 years. The use of a bioprosthesis, longer cardiopulmonary bypass duration and preoperative atrial fibrillation were associated with a higher risk of presenting residual AR. Survival was negatively affected by commonly identified comorbidities (diabetes, stroke, pulmonary disease, renal failure, peripheral vascular disease) but also by the presence of >1/4 residual AR. Survival in the latter group was lower than for patients with ≤1/4 AR at all time points: 91.4 vs 96.7%, 77.5 vs 82.4% and 44.1 vs 54.5% at 1, 5 and 10 years, respectively (P < 0.01).
  
  
  CONCLUSIONS
  Postoperative residual AR >1/4 is an independent predictor of postoperative mortality and should be considered in the selection of surgical approach and management strategy for patients in need of standard and transcatheter aortic valve replacement.
authors.affiliation: Quebec Heart and Lung Institute,  Laval University, Quebec City, Quebec,  Canada.
authors.forename: Sandro
authors.initials: S
authors.lastname: Sponga
authors.forename: Jean
authors.initials: J
authors.lastname: Perron
authors.forename: Francois
authors.initials: F
authors.lastname: Dagenais
authors.forename: Siamak
authors.initials: S
authors.lastname: Mohammadi
authors.forename: Richard
authors.initials: R
authors.lastname: Baillot
authors.forename: Daniel
authors.initials: D
authors.lastname: Doyle
authors.forename: Chiara
authors.initials: C
authors.lastname: Nalli
authors.forename: Pierre
authors.initials: P
authors.lastname: Voisine
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D001022:Aortic Valve Insufficiency / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D006328:Cardiac Catheterization / Q000379:methods; D015331:Cohort Studies; D015150:Echocardiography, Doppler; D017548:Echocardiography, Transesophageal / Q000379:methods; D005260:Female; D006349:Heart Valve Diseases / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects* / Q000379:methods; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000503:physiopathology; D012189:Retrospective Studies; D018709:Statistics, Nonparametric