title: Device-dependent association between paravalvar aortic regurgitation and outcome after TAVI.
abstract: OBJECTIVE
  The aim of the current study was to identify predictors of paraprosthetic aortic regurgitation (AR) after transcatheter aortic valve implantation (TAVI) and examine its influence on short/medium-term mortality using the UK TAVI Registry. TAVI is an effective treatment for high-risk patients with severe symptomatic aortic stenosis (AS), but paraprosthetic AR has been associated with increased in-hospital and mid-term mortality.
  
  
  METHODS
  Between January 2007 and December 2011, 2584 TAVI procedures were performed in the UK. Patients undergoing 'valve-in-valve' procedures, patients with aortic regurgitation as the primary pathology and with no recorded severity of AR were excluded from this analysis (n=144). In total, therefore, 2440 patients were included. Balloon-expandable and self-expanding devices were implanted in 52.7 and 47.2%, respectively, using either transfemoral (67.7%) or non-transfemoral, surgical access (32.3%).
  
  
  RESULTS
  Postprocedural AR was observed in 68%, mild AR in 57% and moderate-severe in 10%. A large aortic annulus, high preprocedural transaortic gradient, and use of self-expanding valve were independent predictors of moderate-severe AR. Moderate-severe (but not mild) AR was associated with increased mortality, and this relationship appeared significant for the balloon-expandable but not the self-expanding device.
  
  
  CONCLUSIONS
  Our data suggest that a large aortic annulus, high preprocedural transaortic gradient, and use of the self-expanding valve predict moderate-severe AR after TAVI. Such a degree of AR is associated with a significantly worse outcome with the balloon-expandable, but not with the self-expanding valve. Further studies are needed to verify this and explore potential mechanisms.
authors: Kings College Hospital, London, UK.
authors: Rafal
authors: R
authors: Dworakowski
authors: Kings College Hospital, London, UK.
authors: Olaf
authors: O
authors: Wendler
authors: Kings College Hospital, London, UK.
authors: Brian
authors: B
authors: Halliday
authors: University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.
authors: Peter
authors: P
authors: Ludman
authors: James Cook University Hospital, Middlesbrough, UK.
authors: Mark
authors: M
authors: DeBelder
authors: University Hospital of South Manchester, UK.
authors: Simon
authors: S
authors: Ray
authors: Royal Brompton and Harefield Hospital, London, UK.
authors: Neil
authors: N
authors: Moat
authors: University Hospitals Leicester NHS Trust, Leicester, UK.
authors: Jan
authors: J
authors: Kovac
authors: University Hospitals Leicester NHS Trust, Leicester, UK.
authors: Tomasz
authors: T
authors: Spyt
authors: Sussex Cardiac Centre, Brighton and Sussex University Hospitals, Brighton, UK.
authors: Uday
authors: U
authors: Trivedi
authors: Sussex Cardiac Centre, Brighton and Sussex University Hospitals, Brighton, UK.
authors: David
authors: D
authors: Hildick-Smith
authors: Leeds General Infirmary, Leeds, UK.
authors: Dan
authors: D
authors: Blackman
authors: National Institute for Cardiovascular Outcome Research, UCL, London, UK.
authors: Damian
authors: D
authors: Marlee
authors: National Institute for Cardiovascular Outcome Research, UCL, London, UK.
authors: David
authors: D
authors: Cunningham
authors: Kings College Hospital, London, UK.
authors: Philip A
authors: PA
authors: MacCarthy
mesh_terms: D000369:Aged, 80 and over; D000704:Analysis of Variance; D001021:Aortic Valve / Q000473:pathology*; D001022:Aortic Valve Insufficiency / Q000209:etiology* / Q000401:mortality / Q000473:pathology; D001024:Aortic Valve Stenosis / Q000401:mortality / Q000601:surgery; D063126:Balloon Valvuloplasty / Q000009:adverse effects / Q000401:mortality; D005260:Female; D006350:Heart Valve Prosthesis / Q000009:adverse effects*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D011183:Postoperative Complications / Q000209:etiology / Q000401:mortality / Q000473:pathology; D011446:Prospective Studies; D065467:Transcatheter Aortic Valve Replacement / Q000009:adverse effects* / Q000401:mortality