title: Aortic regurgitation after transcatheter aortic valve implantation with balloon- and self-expandable prostheses: a pooled analysis from a 2-center experience.
abstract: OBJECTIVE
  This study sought to assess aortic regurgitation (AR) after transcatheter aortic valve implantation (TAVI) with the self-expandable Medtronic CoreValve (MCV) (Medtronic Inc., Minneapolis, Minnesota) versus balloon-expandable Edwards Sapien XT valve (ESV) (Edwards Lifesciences, Irvine, California).
  
  
  BACKGROUND
  AR after TAVI has been associated with poor survival, but limited data exist comparing MCV with ESV.
  
  
  METHODS
  We pooled the prospective TAVI databases of 2 German centers. The primary endpoint was more-than-mild post-TAVI AR assessed by echocardiography. We also assessed device success and survival within 1 year. Endpoints were adjudicated according to the Valve Academic Research Consortium criteria and analyzed by unadjusted and propensity-score-adjusted models.
  
  
  RESULTS
  A total of 394 patients were included, 276 treated with MCV and 118 with ESV. More-than-mild AR was significantly higher with MCV than with ESV (12.7% vs. 2.6%, p = 0.002). This difference remained significant after propensity adjustment (adjusted odds ratio [OR]: 4.59, 95% confidence interval [CI]: 1.03 to 20.44). The occurrence of any degree of AR was also higher with MCV (71.6% vs. 56.9%, p = 0.004). Device success was mainly influenced by the occurrence of AR and was consequently higher with ESV (95.8% vs. 86.6%, p = 0.007), but this was not significant after propensity adjustment (adjusted OR: 0.34, 95% CI: 0.11 to 1.03, p = 0.06). At 1 year, survival was comparable between both valve types (83.8% MCV vs. 88.2% ESV, p = 0.42), but was significantly worse in patients with more-than-mild AR (69.8% vs. 87.4%, p = 0.004) and in those with device failure (65.6% vs. 87.4%, p < 0.001).
  
  
  CONCLUSIONS
  More-than-mild AR after TAVI was more frequent with MCV than with ESV. This finding deserves consideration, as more-than-mild AR was associated with higher mortality at 1 year.
authors.affiliation: Cardiology Department, Heart Center, Segeberger Kliniken, Bad Segeberg, Germany. Electronic address: mohamed.abdel-wahab@segebergerkliniken.de.
authors.forename: Mohamed
authors.initials: M
authors.lastname: Abdel-Wahab
authors.affiliation: Cardiology Department, University Heart Center Bad Krozingen, Bad Krozingen, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Comberg
authors.affiliation: Cardiology Department, University Heart Center Bad Krozingen, Bad Krozingen, Germany.
authors.forename: Heinz Joachim
authors.initials: HJ
authors.lastname: Büttner
authors.affiliation: Cardiology Department, Heart Center, Segeberger Kliniken, Bad Segeberg, Germany.
authors.forename: Mohamed
authors.initials: M
authors.lastname: El-Mawardy
authors.affiliation: Cardiology Department, Heart Center, Segeberger Kliniken, Bad Segeberg, Germany.
authors.forename: Kenichi
authors.initials: K
authors.lastname: Chatani
authors.affiliation: Cardiology Department, University Heart Center Bad Krozingen, Bad Krozingen, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Gick
authors.affiliation: Cardiology Department, Heart Center, Segeberger Kliniken, Bad Segeberg, Germany.
authors.forename: Volker
authors.initials: V
authors.lastname: Geist
authors.affiliation: Cardiology Department, Heart Center, Segeberger Kliniken, Bad Segeberg, Germany.
authors.forename: Gert
authors.initials: G
authors.lastname: Richardt
authors.affiliation: Cardiology Department, University Heart Center Bad Krozingen, Bad Krozingen, Germany.
authors.forename: Franz-Josef
authors.initials: FJ
authors.lastname: Neumann
mesh_terms: D000369:Aged, 80 and over; D000792:Angiography; D001022:Aortic Valve Insufficiency / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology*; D016001:Confidence Intervals; D017548:Echocardiography, Transesophageal; D005260:Female; D005500:Follow-Up Studies; D015637:Gated Blood-Pool Imaging; D005858:Germany / Q000453:epidemiology; D006350:Heart Valve Prosthesis; D006801:Humans; D015994:Incidence; D008297:Male; D016017:Odds Ratio; D011183:Postoperative Complications; D057216:Propensity Score; D011446:Prospective Studies; D011474:Prosthesis Design; D012042:Registries; D018570:Risk Assessment / Q000379:methods; D012307:Risk Factors; D012720:Severity of Illness Index; D015996:Survival Rate / Q000639:trends; D014057:Tomography, X-Ray Computed; D065467:Transcatheter Aortic Valve Replacement / Q000009:adverse effects* / Q000379:methods; D016896:Treatment Outcome
keywords: aortic regurgitation; device success; outcome; transcatheter aortic valve implantation