Influence of aortic regurgitation after TAVI on left ventricular filling pattern.
BACKGROUND
Paravalvular aortic regurgitation after transcatheter aortic valve implantation is associated with a hemodynamic deterioration and a poor outcome. We aim to determine the early hemodynamic effect of paravalvular aortic regurgitation in relation with the change in the left ventricle filling pattern and to assess their clinical outcome.


METHODS
Eighty-two consecutive patients referred for transcatheter aortic valve implantation were included. Patients were classified according to the change in the left ventricular filling pattern, and significant paravalvular aortic regurgitation (grade ≥ 2) was reported. Follow-up and incidence of death and hospitalization for heart failure were reported.


RESULTS
Sixteen patients (19·5%) presented a worsening of left ventricular filling pattern. The incidence of significant paravalvular aortic regurgitation was higher in the group with a worsening of left ventricular filling pattern (56·3% vs. 19·7%; P = 0·009). In the multivariate analysis, the only variable significantly associated with the worsening of left ventricular filling pattern was the significant paravalvular aortic regurgitation (OR 4·84; 95% CI 1·23 - 19·1; P = 0·024). During the follow-up (642·5 days), there was a higher incidence of the endpoint of death or hospitalization for heart failure in the group with a worsening of left ventricular filling pattern (62·5% vs. 31·8%; P = 0·042) and a lower event-free survival rate (long rank test = 0·013).


CONCLUSIONS
The presence of a significant paravalvular aortic regurgitation is associated with a worsening in parameters of diastolic function. This finding should alert the cardiologist as patients with a worsening of left ventricular filling pattern present a higher incidence of paravalvular aortic regurgitation and a less favourable outcome.
Department of Cardiology, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain.
Luis
L
Caballero
Daniel
D
Saura
Juan
J
García-Lara
Maria José
MJ
Oliva
Eduardo
E
Pinar
Josefa
J
González-Carrillo
Miguel
M
García-Navarro
Maria Dolores
MD
Espinosa
Mariano
M
Valdés
Gonzalo
G
de la Morena
D000368:Aged; D000369:Aged, 80 and over; D001022:Aortic Valve Insufficiency / Q000209:etiology* / Q000503:physiopathology; D001024:Aortic Valve Stenosis / Q000601:surgery*; D018450:Disease Progression; D004452:Echocardiography / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D065467:Transcatheter Aortic Valve Replacement / Q000009:adverse effects*; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000209:etiology* / Q000503:physiopathology
Diastolic function; Transcatheter aortic valve implantation; paravalvular aortic regurgitation