title: Impact of aortic regurgitation after transcatheter aortic valve implantation: results from the REVIVAL trial.
abstract: OBJECTIVE
  Understanding the severity of aortic regurgitation (AR) after transcatheter aortic valve implantation, its impact on left ventricular (LV) structure and function, and the structural factors associated with worsening AR could lead to improvements in patient selection, implantation technique, and valve design.
  
  
  BACKGROUND
  Initial studies in patients at high risk of surgical aortic valve replacement have reported both central valvular and paravalvular AR after transcatheter aortic valve implantation.
  
  
  METHODS
  Transthoracic echocardiograms were quantified from 95 patients in the REVIVAL (TRanscatheter EndoVascular Implantation of VALves) trial. Transthoracic echocardiograms were obtained before implantation of the Edwards-Sapien valve (Edwards Lifesciences, Irvine, California) and thereafter at selected intervals. Measurements included LV internal diameters and volumes, ejection fraction, aortic valve area, and the degree of aortic regurgitation. Measures of degree of native leaflet mobility, thickness, and calcification, as well as left ventricular outflow tract, aortic annulus, and aortic root diameters were also made.
  
  
  RESULTS
  Eighty-four patients remained after 11 were excluded; 26 (29.8%) died over a period of 3 years. At 24 h post-implantation, 75% had some degree of AR, mostly paravalvular. By 1 year, the mean AR grade increased slightly, but not significantly (1.1 ± 0.8 to 1.3 ± 0.9), and all measures of LV structure and function improved (LV ejection fraction, 50.7 ± 16.1% to 59.4 ± 14.0%). Native aortic leaflet calcification and annulus diameter correlated significantly with the severity of AR at 1 year (p < 0.05).
  
  
  CONCLUSIONS
  AR after transcatheter aortic valve implantation is frequent but is rarely more than mild. Although AR progresses, it is not associated with a harmful impact on LV structure and function over the first year. Native valve calcification and aortic annulus diameter influence the degree of AR at 6 months.
authors.affiliation: Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA. kibaryared@yahoo.com
authors.forename: Kibar
authors.initials: K
authors.lastname: Yared
authors.forename: Tamara
authors.initials: T
authors.lastname: Garcia-Camarero
authors.forename: Leticia
authors.initials: L
authors.lastname: Fernandez-Friera
authors.forename: Miguel
authors.initials: M
authors.lastname: Llano
authors.forename: Ronen
authors.initials: R
authors.lastname: Durst
authors.forename: Anil A
authors.initials: AA
authors.lastname: Reddy
authors.forename: William W
authors.initials: WW
authors.lastname: O'Neill
authors.forename: Michael H
authors.initials: MH
authors.lastname: Picard
mesh_terms: D001022:Aortic Valve Insufficiency / Q000000981:diagnostic imaging / Q000209:etiology* / Q000401:mortality / Q000503:physiopathology; D001024:Aortic Valve Stenosis / Q000401:mortality / Q000628:therapy*; D006328:Cardiac Catheterization / Q000009:adverse effects* / Q000401:mortality; D016009:Chi-Square Distribution; D018618:Echocardiography, Doppler, Color; D005240:Feasibility Studies; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects* / Q000379:methods / Q000401:mortality; D006801:Humans; D016014:Linear Models; D011237:Predictive Value of Tests; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D013318:Stroke Volume; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States; D016277:Ventricular Function, Left; D020257:Ventricular Remodeling