title: CoreValve implantation for severe aortic regurgitation: a multicentre registry.
abstract: We sought to evaluate the outcome of transcatheter aortic valve replacement (TAVR) with the CoreValve Revalving System (CRS-TAVR) in inoperable patients presenting with severe aortic regurgitation (AR), compared to in patients treated for severe native aortic stenosis (AS). From October 2008 to January 2013, 1,557 consecutive patients undergoing CRS-TAVR, of whom 26 (1.6%) presented with AR, were prospectively followed. Compared with patients with AS, patients with AR were significantly younger (mean age 73±10 vs. 82±6, p=0.02), more frequently in NYHA Class III/IV (95% vs. 73%, p=0.01) and had a higher incidence of severe pulmonary hypertension (sPAP >60 mmHg, 31% vs. 10%, p=0.007). Log EuroSCORE and STS score were similar. VARC-2-defined device success was lower in the AR group (79% vs. 96%, p=0.006). At one month, patients treated for AR had a higher overall mortality (23% vs. 5.9%; OR 4.22 [3.03-8.28], p<0.001) and cardiac mortality (15.3% vs. 4%, OR 4.01 [2.40-7.66], p<0.001). Results were consistent at 12 months: overall mortality (31% vs. 19%, HR 2.1 [1.5-4.41], p<0.001) and cardiac mortality (19.2% vs. 6%, HR 3.1 [2.09-8.22], p<0.001). CRS-TAVR for AR is associated with a significantly higher mortality compared to CRS-TAVR for AS. Considering the ominous prognosis of these patients when treated medically, TAVR may be a reasonable choice in selected patients. In this regard, conventional risk scores have an inadequate predictive value.
authors.affiliation: Istituto Clinico S. Ambrogio, Milan, Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: Testa
authors.forename: Azeem
authors.initials: A
authors.lastname: Latib
authors.forename: Marco Luciano
authors.initials: ML
authors.lastname: Rossi
authors.forename: Federico
authors.initials: F
authors.lastname: De Marco
authors.forename: Marco
authors.initials: M
authors.lastname: De Carlo
authors.forename: Claudia
authors.initials: C
authors.lastname: Fiorina
authors.forename: Jacopo
authors.initials: J
authors.lastname: Oreglia
authors.forename: Anna Sonia
authors.initials: AS
authors.lastname: Petronio
authors.forename: Federica
authors.initials: F
authors.lastname: Ettori
authors.forename: Stefano
authors.initials: S
authors.lastname: De Servi
authors.forename: Silvio
authors.initials: S
authors.lastname: Klugmann
authors.forename: Gian Paolo
authors.initials: GP
authors.lastname: Ussia
authors.forename: Corrado
authors.initials: C
authors.lastname: Tamburino
authors.forename: Paolo
authors.initials: P
authors.lastname: Panisi
authors.forename: Nedy
authors.initials: N
authors.lastname: Brambilla
authors.forename: Antonio
authors.initials: A
authors.lastname: Colombo
authors.forename: Patrizia
authors.initials: P
authors.lastname: Presbitero
authors.forename: Francesco
authors.initials: F
authors.lastname: Bedogni
mesh_terms: D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000601:surgery*; D001022:Aortic Valve Insufficiency / Q000401:mortality / Q000601:surgery*; D001024:Aortic Valve Stenosis / Q000401:mortality / Q000601:surgery*; D002037:Bundle-Branch Block / Q000453:epidemiology; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000379:methods / Q000401:mortality*; D006801:Humans; D006976:Hypertension, Pulmonary / Q000453:epidemiology; D007558:Italy / Q000453:epidemiology; D012042:Registries; D012720:Severity of Illness Index