title: Incidence, outcome and correlates of residual paravalvular aortic regurgitation after transcatheter aortic valve implantation and importance of haemodynamic assessment.
abstract: OBJECTIVE
  Residual paravalvular aortic regurgitation (PAR) after transcatheter aortic valve implantation (TAVI) is common. We therefore evaluated incidence, determinants and outcome of PAR after TAVI.
  
  
  RESULTS
  Data from 167 consecutive transcatheter TAVI patients were analysed. PAR was graded by angiography and the pressure gradient between diastolic aortic pressure and left ventricular end-diastolic pressure (∆PDAP-LVEDP) after implantation. TAVI was technically successful in all patients. Mortality was 9% and 20% at 30 days and one year, respectively. Post-procedural PAR was absent in 54 patients (32.3%). Mild PAR was found in 89 (53.3%), moderate in 21 (12.6%), and moderate-to-severe in three patients (1.8%). Cardiovascular mortality at 30 days and one year was increased in patients with moderate and moderate-to-severe PAR compared to patients with no and mild PAR (46% vs. 4% and 73% vs. 7%, respectively, p<0.001). Receiver operating characteristic curve analysis suggested ∆PDAP-LVEDP ≤18 mmHg as a novel predictor of mortality, with an area under the curve of 0.97.
  
  
  CONCLUSIONS
  In patients undergoing TAVI, moderate and moderate-to-severe PAR was observed in 14.4% and associated with increased cardiovascular mortality. A pressure gradient ∆PDAP-LVEDP≤18 mmHg carries adverse prognosis and requires further intervention.
authors.affiliation: Department of Cardiology, West German Heart Center Essen, Essen University Hospital, University Duisburg-Essen, Essen, Germany. polykarpos-christos.patsalis@uk-essen.de
authors.forename: Polykarpos C
authors.initials: PC
authors.lastname: Patsalis
authors.forename: Thomas F M
authors.initials: TF
authors.lastname: Konorza
authors.forename: Fadi
authors.initials: F
authors.lastname: Al-Rashid
authors.forename: Björn
authors.initials: B
authors.lastname: Plicht
authors.forename: Matthias
authors.initials: M
authors.lastname: Riebisch
authors.forename: Daniel
authors.initials: D
authors.lastname: Wendt
authors.forename: Matthias
authors.initials: M
authors.lastname: Thielmann
authors.forename: Heinz
authors.initials: H
authors.lastname: Jakob
authors.forename: Holger
authors.initials: H
authors.lastname: Eggebrecht
authors.forename: Gerd
authors.initials: G
authors.lastname: Heusch
authors.forename: Raimund
authors.initials: R
authors.lastname: Erbel
authors.forename: Philipp
authors.initials: P
authors.lastname: Kahlert
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000503:physiopathology*; D001022:Aortic Valve Insufficiency / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality / Q000503:physiopathology; D001024:Aortic Valve Stenosis / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D019540:Area Under Curve; D062186:Arterial Pressure; D006328:Cardiac Catheterization / Q000009:adverse effects* / Q000401:mortality; D016009:Chi-Square Distribution; D005260:Female; D005858:Germany / Q000453:epidemiology; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects* / Q000379:methods / Q000401:mortality; D006439:Hemodynamics; D006801:Humans; D015994:Incidence; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D012372:ROC Curve; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome; D016277:Ventricular Function, Left; D017725:Ventricular Pressure