title: Postprocedural aortic regurgitation in balloon-expandable and self-expandable transcatheter aortic valve replacement procedures: analysis of predictors and impact on long-term mortality: insights from the FRANCE2 Registry.
abstract: BACKGROUND
  Significant postprocedural aortic regurgitation (AR) is observed in 10% to 20% of cases after transcatheter aortic valve replacement (TAVR). The prognostic value and the predictors of such a complication in balloon-expandable (BE) and self-expandable (SE) TAVR remain unclear.
  
  
  RESULTS
  TAVR was performed in 3195 consecutive patients at 34 hospitals. Postprocedural transthoracic echocardiography was performed in 2769 (92%) patients of the eligible population, and these patients constituted the study group. Median follow-up was 306 days (Q1-Q3=178-490). BE and SE devices were implanted in 67.6% (n=1872) and 32.4% (n=897). Delivery was femoral (75.3%) or nonfemoral (24.7%). A postprocedural AR≥grade 2 was observed in 15.8% and was more frequent in SE (21.5%) than in BE-TAVR (13.0%, P=0.0001). Extensive multivariable analysis confirmed that the use of a SE device was one of the most powerful independent predictors of postprocedural AR≥grade 2. For BE-TAVR, 8 independent predictors of postprocedural AR≥grade 2 were identified including femoral delivery (P=0.04), larger aortic annulus (P=0.0004), and smaller prosthesis diameter (P=0.0001). For SE-TAVR, 2 independent predictors were identified including femoral delivery(P=0.0001). Aortic annulus and prosthesis diameter were not predictors of postprocedural AR for SE-TAVR. A postprocedural AR≥grade 2, but not a postprocedural AR=grade 1, was a strong independent predictor of 1-year mortality for BE (hazard ratio=2.50; P=0.0001) and SE-TAVR (hazard ratio=2.11; P=0.0001). Although postprocedural AR≥grade 2 was well tolerated in patients with AR≥grade 2 at baseline (1-year mortality=7%), it was associated with a very high mortality in other subgroups: renal failure (43%), AR<grade 2 at baseline (31%), low transaortic gradient (35%), or nonfemoral delivery (45%).
  
  
  CONCLUSIONS
  Postprocedural AR≥grade 2 was observed in 15.8% of successful TAVR and was the strongest independent predictor of 1-year mortality. The use of the SE device was a powerful independent predictor of postprocedural AR≥grade 2.
authors.affiliation: Department of Cardiology, University Hospital, Lille, France (E.V.B., F.J., A.V., C.B., J.-L.A., C.D., A.P.); EA2693, Lille-II-University, Lille, France (E.V.B., F.J., S.S., A.V., C.B., J.-L.A., C.D., A.P.); INSERM-U744, Lille, France (J.D.); CHU Bichat, Paris, France (B.I.); CHU Rouen, Rouen, France (H.E.); CHU Dupuytren, Limoges, France (M. Laskar); CHU Pitié-Salpêtrière, Paris, France (P.L.); University Lyon-1, Lyon, France (M. Lievre; Institut cardiovasculaire Paris-Sud, Paris, France (P.D.-G.); URC-ECO, Paris, France (K.C.); Clinique Pasteur, Toulouse, France (J.F.); CHU Rennes, Rennes, France (A.L.); CHU Brest, Brest, France (M.G.); and CHU Mondor Créteil, Créteil, France (E.T.).
authors.forename: Eric
authors.initials: E
authors.lastname: Van Belle
authors.forename: Françis
authors.initials: F
authors.lastname: Juthier
authors.forename: Sophie
authors.initials: S
authors.lastname: Susen
authors.forename: André
authors.initials: A
authors.lastname: Vincentelli
authors.forename: Bernard
authors.initials: B
authors.lastname: Iung
authors.forename: Jean
authors.initials: J
authors.lastname: Dallongeville
authors.forename: Hélène
authors.initials: H
authors.lastname: Eltchaninoff
authors.forename: Marc
authors.initials: M
authors.lastname: Laskar
authors.forename: Pascal
authors.initials: P
authors.lastname: Leprince
authors.forename: Michel
authors.initials: M
authors.lastname: Lievre
authors.forename: Carlo
authors.initials: C
authors.lastname: Banfi
authors.forename: Jean-Luc
authors.initials: JL
authors.lastname: Auffray
authors.forename: Cedric
authors.initials: C
authors.lastname: Delhaye
authors.forename: Patrick
authors.initials: P
authors.lastname: Donzeau-Gouge
authors.forename: Karine
authors.initials: K
authors.lastname: Chevreul
authors.forename: Jean
authors.initials: J
authors.lastname: Fajadet
authors.forename: Alain
authors.initials: A
authors.lastname: Leguerrier
authors.forename: Alain
authors.initials: A
authors.lastname: Prat
authors.forename: Martine
authors.initials: M
authors.lastname: Gilard
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Teiger
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000601:surgery*; D001022:Aortic Valve Insufficiency / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000401:mortality* / Q000601:surgery; D001024:Aortic Valve Stenosis / Q000000981:diagnostic imaging / Q000601:surgery; D063126:Balloon Valvuloplasty / Q000379:methods*; D004452:Echocardiography; D005260:Female; D005500:Follow-Up Studies; D005602:France; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000379:methods*; D006801:Humans; D015994:Incidence; D008137:Longitudinal Studies; D008297:Male; D011183:Postoperative Complications / Q000453:epidemiology* / Q000401:mortality*; D011237:Predictive Value of Tests; D011379:Prognosis; D012042:Registries; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome
keywords: aortic valve; aortic valve insufficiency; aortic valve stenosis