title: Incidence, predictors, and outcomes of aortic regurgitation after transcatheter aortic valve replacement: meta-analysis and systematic review of literature.
abstract: OBJECTIVE
  This study was designed to establish the incidence, impact, and predictors of post-transcatheter aortic valve replacement (TAVR) aortic regurgitation (AR).
  
  
  BACKGROUND
  AR is an important limitation of TAVR with ill-defined predictors and unclear long-term impact on outcomes.
  
  
  METHODS
  Studies published between 2002 and 2012 with regard to TAVR were identified using an electronic search and reviewed using the random-effects model of DerSimonian and Laird. From 3,871 initial citations, 45 studies reporting on 12,926 patients (CoreValve [Medtronic CV Luxembourg S.a.r.l., Tolochenaz, Switzerland] n = 5,261 and Edwards valve [Edwards Lifesciences, Santa Ana, California] n = 7,279) were included in the analysis of incidence and outcomes of post-TAVR AR.
  
  
  RESULTS
  The pooled estimate for moderate or severe AR post-TAVR was 11.7% (95% confidence interval [CI]: 9.6 to 14.1). Moderate or severe AR was more common with use of the CoreValve (16.0% vs. 9.1%, p = 0.005). The presence of moderate or severe AR post-TAVR increased mortality at 30 days (odds ratio: 2.95; 95% CI: 1.73 to 5.02) and 1 year (hazard ratio: 2.27; 95% CI: -1.84 to 2.81). Mild AR was also associated with an increased hazard ratio for mortality, 1.829 (95% CI: 1.005 to 3.329) that was overturned by sensitivity analysis. Twenty-five studies reported on predictors of post-TAVR AR. Implantation depth, valve undersizing, and Agatston calcium score (r = 0.47, p = 0.001) were identified as important predictors.
  
  
  CONCLUSIONS
  Moderate or severe aortic regurgitation is common after TAVR and an adverse prognostic indicator of short- and long-term survival. Incidence of moderate or severe AR is higher with use of the CoreValve. Mild AR may be associated with increased long-term mortality. Therefore, every effort should be made to minimize AR by a comprehensive pre-procedural planning and meticulous procedural execution.
authors.affiliation: Department of Cardiovascular Medicine, Heart & Vascular Institute, Cleveland Clinic, Cleveland, Ohio 44195, USA.
authors.forename: Ganesh
authors.initials: G
authors.lastname: Athappan
authors.forename: Eshan
authors.initials: E
authors.lastname: Patvardhan
authors.forename: E Murat
authors.initials: EM
authors.lastname: Tuzcu
authors.forename: Lars Georg
authors.initials: LG
authors.lastname: Svensson
authors.forename: Pedro A
authors.initials: PA
authors.lastname: Lemos
authors.forename: Chiara
authors.initials: C
authors.lastname: Fraccaro
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Tarantini
authors.forename: Jan-Malte
authors.initials: JM
authors.lastname: Sinning
authors.forename: Georg
authors.initials: G
authors.lastname: Nickenig
authors.forename: Davide
authors.initials: D
authors.lastname: Capodanno
authors.forename: Corrado
authors.initials: C
authors.lastname: Tamburino
authors.forename: Azeem
authors.initials: A
authors.lastname: Latib
authors.forename: Antonio
authors.initials: A
authors.lastname: Colombo
authors.forename: Samir R
authors.initials: SR
authors.lastname: Kapadia
mesh_terms: D001021:Aortic Valve / Q000601:surgery*; D001022:Aortic Valve Insufficiency / Q000453:epidemiology / Q000209:etiology / Q000503:physiopathology; D001024:Aortic Valve Stenosis / Q000601:surgery; D006328:Cardiac Catheterization / Q000379:methods; D003625:Data Collection; D019544:Equipment Failure Analysis / Q000706:statistics & numerical data*; D006350:Heart Valve Prosthesis / Q000009:adverse effects / Q000592:standards; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods; D006801:Humans; D015994:Incidence; D053208:Kaplan-Meier Estimate; D011183:Postoperative Complications / Q000453:epidemiology / Q000503:physiopathology; D011474:Prosthesis Design / Q000592:standards; D011475:Prosthesis Failure / Q000209:etiology*; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D016896:Treatment Outcome