title: Clinical impact of aortic regurgitation after transcatheter aortic valve replacement: insights into the degree and acuteness of presentation.
abstract: OBJECTIVE
  The aim of this study was to determine the impact of the degree of residual aortic regurgitation (AR) and acuteness of presentation of AR after transcatheter aortic valve replacement (TAVR) on outcomes.
  
  
  BACKGROUND
  The degree of residual AR after TAVR leading to excess mortality remains controversial, and little evidence exists on the impact of the acuteness of presentation of AR.
  
  
  METHODS
  A total of 1,735 patients undergoing TAVR with balloon-expandable or self-expanding valves were included. The presence and degree of AR were evaluated by transthoracic echocardiography; acute AR was defined as an increase in AR severity of ≥1 degree compared with pre-procedural echocardiography.
  
  
  RESULTS
  Residual AR was classified as mild in 761 patients (43.9%) and moderate to severe in 247 patients (14.2%). The presence of moderate to severe AR was an independent predictor of mortality at a mean follow-up of 21 ± 17 months compared with none to trace (adjusted hazard ratio [HR]: 1.81, 95% confidence interval [CI]: 1.32 to 2.48; p < 0.001) and mild AR (adjusted HR: 1.68, 95% CI: 1.27 to 2.24; p < 0.001) groups. There was no increased risk in patients with mild AR compared with those with none to trace AR (p = 0.393). In patients with moderate to severe AR, acute AR was observed in 161 patients (65%) and chronic AR in 86 patients (35%). Acute moderate to severe AR was independently associated with increased risk of mortality compared with none/trace/mild AR (adjusted HR: 2.37, 95% CI: 1.53 to 3.66; p < 0.001) and chronic moderate to severe AR (adjusted HR: 2.24, 95% CI: 1.17 to 4.30; p = 0.015) [corrected]. No differences in survival rate were observed between patients with chronic moderate to severe and none/trace/mild AR (p > 0.50).
  
  
  CONCLUSIONS
  AR occurred very frequently after TAVR, but an increased risk of mortality at ∼2-year follow-up was observed only in patients with acute moderate to severe AR.
authors.affiliation: Quebec Heart & Lung Institute, Laval University, Quebec City, Quebec, Canada.
authors.forename: Miguel
authors.initials: M
authors.lastname: Jerez-Valero
authors.affiliation: Quebec Heart & Lung Institute, Laval University, Quebec City, Quebec, Canada.
authors.forename: Marina
authors.initials: M
authors.lastname: Urena
authors.affiliation: St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: John G
authors.initials: JG
authors.lastname: Webb
authors.affiliation: Ferrarotto Hospital, University of Catania, Catania, Italy.
authors.forename: Corrado
authors.initials: C
authors.lastname: Tamburino
authors.affiliation: Hospital Universitario Virgen de la Victoria de Málaga, Universidad de Malaga, Malaga, Spain.
authors.forename: Antonio J
authors.initials: AJ
authors.lastname: Munoz-Garcia
authors.affiliation: St. Michael's Hospital, Toronto University, Toronto, Ontario, Canada.
authors.forename: Asim
authors.initials: A
authors.lastname: Cheema
authors.affiliation: Clìnica de Occidente de Cali, Cali, Colombia.
authors.forename: Antonio E
authors.initials: AE
authors.lastname: Dager
authors.affiliation: Hospital Universitari Vall d'Hebron, Barcelona, Spain.
authors.forename: Vicenç
authors.initials: V
authors.lastname: Serra
authors.affiliation: Hospital Clinico Universitario de Valladolid, Valladolid, Spain.
authors.forename: Ignacio J
authors.initials: IJ
authors.lastname: Amat-Santos
authors.affiliation: St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada; Ferrarotto Hospital, University of Catania, Catania, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Barbanti
authors.affiliation: Ferrarotto Hospital, University of Catania, Catania, Italy.
authors.forename: Sebastiano
authors.initials: S
authors.lastname: Immè
authors.affiliation: Hospital Universitario Virgen de la Victoria de Málaga, Universidad de Malaga, Malaga, Spain.
authors.forename: Juan H
authors.initials: JH
authors.lastname: Alonso Briales
authors.affiliation: St. Michael's Hospital, Toronto University, Toronto, Ontario, Canada.
authors.forename: Hatim
authors.initials: H
authors.lastname: Al Lawati
authors.affiliation: Clìnica de Occidente de Cali, Cali, Colombia.
authors.forename: Luis Miguel
authors.initials: LM
authors.lastname: Benitez
authors.affiliation: Clìnica de Occidente de Cali, Cali, Colombia.
authors.forename: Angela Maria
authors.initials: AM
authors.lastname: Cucalon
authors.affiliation: Hospital Universitari Vall d'Hebron, Barcelona, Spain.
authors.forename: Bruno
authors.initials: B
authors.lastname: Garcia del Blanco
authors.affiliation: Hospital Clinico Universitario de Valladolid, Valladolid, Spain.
authors.forename: Ana
authors.initials: A
authors.lastname: Revilla
authors.affiliation: Quebec Heart & Lung Institute, Laval University, Quebec City, Quebec, Canada.
authors.forename: Eric
authors.initials: E
authors.lastname: Dumont
authors.affiliation: Quebec Heart & Lung Institute, Laval University, Quebec City, Quebec, Canada.
authors.forename: Henrique
authors.initials: H
authors.lastname: Barbosa Ribeiro
authors.affiliation: Quebec Heart & Lung Institute, Laval University, Quebec City, Quebec, Canada.
authors.forename: Luis
authors.initials: L
authors.lastname: Nombela-Franco
authors.affiliation: Quebec Heart & Lung Institute, Laval University, Quebec City, Quebec, Canada.
authors.forename: Sébastien
authors.initials: S
authors.lastname: Bergeron
authors.affiliation: Quebec Heart & Lung Institute, Laval University, Quebec City, Quebec, Canada.
authors.forename: Philippe
authors.initials: P
authors.lastname: Pibarot
authors.affiliation: Quebec Heart & Lung Institute, Laval University, Quebec City, Quebec, Canada. Electronic address: josep.rodes@criucpq.ulaval.ca.
authors.forename: Josep
authors.initials: J
authors.lastname: Rodés-Cabau
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000000981:diagnostic imaging / 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*; D063126:Balloon Valvuloplasty / Q000009:adverse effects; D002170:Canada; D006328:Cardiac Catheterization / Q000009:adverse effects* / Q000295:instrumentation / Q000401:mortality; D005260:Female; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects* / Q000295:instrumentation / Q000379:methods / Q000401:mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008943:Mitral Valve / Q000000981:diagnostic imaging / Q000503:physiopathology; D008944:Mitral Valve Insufficiency / Q000175:diagnosis / Q000503:physiopathology; D016016:Proportional Hazards Models; D011474:Prosthesis Design; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D013030:Spain; D013318:Stroke Volume; D013997:Time Factors; D016896:Treatment Outcome; D014463:Ultrasonography; D016277:Ventricular Function, Left
keywords: acute aortic regurgitation; aortic regurgitation; mitral regurgitation; paravalvular leak; transcatheter aortic valve implantation; transcatheter aortic valve replacement