title: Impact of post-procedural aortic regurgitation on mortality after transcatheter aortic valve implantation.
abstract: OBJECTIVE
  The goal of the study was to clarify the impact of post-procedural aortic regurgitation (post-AR) grade 2/4 on clinical outcomes.
  
  
  BACKGROUND
  Post-AR >2/4 is known to be associated with poor short- to midterm outcome after transcatheter aortic valve implantation (TAVI).
  
  
  METHODS
  We compared clinical outcomes in 400 consecutive TAVI recipients according to post-AR grade: grade 0 or 1 (group 1 = 74.8%), grade 2 (group 2 = 22.2%), or grade 3 or 4 (group 3 = 3.0%).
  
  
  RESULTS
  The mean age was similar in the 3 groups (83.4 ± 6.1 years) as was the logistic EuroSCORE (22.5 ± 11.4%, 24.5 ± 11.6%, and 21.5 ± 9.4%, p = 0.28) and annulus size (22.0 ± 1.8, 22.2 ± 2.1, and 22.5 ± 2.1 mm, p = 0.53). The Edwards valve was most frequently used in group 1 compared with groups 2 and 3 (89.3%, 78.7%, and 83.3%, p = 0.03), and the implanted valve size was similar in all groups (25.6 ± 2.0, 25.4 ± 2.2, and 25.5 ± 2.2 mm, respectively, p = 0.69). Post-dilation was required more frequently in group 3 (4.7%, 24.1%, and 50.0%, respectively, p < 0.01). Post-procedural increase in mitral regurgitation was in line with the post-AR grade (0.78 ± 0.73, 1.22 ± 0.80, and 1.89 ± 0.78, respectively, p < 0.01). Despite the absence of difference in 30-day mortality, longer-term outcome was significantly poorer in patients with AR grade 2 than in those with AR grade 0 or 1 (log-rank p < 0.01), albeit better than in patients with AR grade 3 or 4 (p = 0.04), regardless of TAVI type and left ventricular function. Post-AR ≥2/4 was also identified as an independent predictor of mid- to long-term mortality (hazard ratio: 1.68, 95% confidence interval: 1.21 to 1.44, p < 0.01).
  
  
  CONCLUSIONS
  Post-AR grade 2/4 after TAVI is associated with worse outcome compared with grade 0 or 1. Careful valve selection and post-dilation when required to avoid post-AR grade 2 may contribute to improved clinical outcome after TAVI.
authors.affiliation: Institut Cardiovasculaire Paris Sud, Massy, France.
authors.forename: Kentaro
authors.initials: K
authors.lastname: Hayashida
authors.forename: Thierry
authors.initials: T
authors.lastname: Lefèvre
authors.forename: Bernard
authors.initials: B
authors.lastname: Chevalier
authors.forename: Thomas
authors.initials: T
authors.lastname: Hovasse
authors.forename: Mauro
authors.initials: M
authors.lastname: Romano
authors.forename: Philippe
authors.initials: P
authors.lastname: Garot
authors.forename: Erik
authors.initials: E
authors.lastname: Bouvier
authors.forename: Arnaud
authors.initials: A
authors.lastname: Farge
authors.forename: Patrick
authors.initials: P
authors.lastname: Donzeau-Gouge
authors.forename: Bertrand
authors.initials: B
authors.lastname: Cormier
authors.forename: Marie-Claude
authors.initials: MC
authors.lastname: Morice
mesh_terms: D000369:Aged, 80 and over; D001021:Aortic Valve / Q000601:surgery*; D001022:Aortic Valve Insufficiency / Q000209:etiology* / Q000401:mortality*; D001024:Aortic Valve Stenosis / Q000601:surgery*; D006328:Cardiac Catheterization; D005260:Female; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects* / Q000379:methods*; D006801:Humans; D008297:Male; D011446:Prospective Studies