title: Effect of aortic regurgitation following transcatheter aortic valve implantation on outcomes.
abstract: The prognosis of aortic regurgitation (AR) after transcatheter aortic valve implantation (TAVI) and the changes in AR grade over time remain unclear. This study evaluated the midterm survival associated with AR after TAVI and examined the evolution of AR over time and its effect on cardiac performance. Successful TAVI was performed in 314 patients (age 81 ± 7 years, 36% men). Serial transthoracic echocardiography and clinical assessment were available in 175 patients who survived >12 months. AR was assessed in terms of overall, paravalvular, and intravalvular severity. Significant post-TAVI AR (grade ≥2) was observed in 82 patients (26%), and these patients showed a trend toward reduced survival at 1- (93% vs 91%) and 2-year (89% vs 74%, log-rank p = 0.063) follow-up. Of the 175 patients who survived >12 months, grade ≥2 overall, paravalvular, and intravalvular AR were noted in 47 (27%), 32 (18%), and 8 patients (5%), respectively. Significant overall and paravalvular AR appeared to improve over time, particularly during the first 6 months (p <0.05), whereas intravalvular AR remained unchanged. Although improvements in the echocardiographic parameters were similar among patients with and without significant AR, patients who remained with grade ≥2 AR at 6 months had significantly worse survival than their counterparts at 2 years (80% vs 94%, log-rank p = 0.032). In conclusion, significant overall and paravalvular AR after TAVI appeared to improve over time. Although improvements in the echocardiographic parameters were similar, patients with grade ≥2 AR, both immediately after TAVI and at 6 months, were associated with worse survival.
authors.affiliation: Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands; Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, The Netherlands; Department of Cardiology, National Heart Centre Singapore, Singapore, Singapore.
authors.forename: See Hooi
authors.initials: SH
authors.lastname: Ewe
authors.affiliation: Centro Cardiologico Monzino, IRCCS, Milan, Italy; Cardiovascular Section, Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.
authors.forename: Manuela
authors.initials: M
authors.lastname: Muratori
authors.affiliation: Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands; Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: Frank
authors.initials: F
authors.lastname: van der Kley
authors.affiliation: Centro Cardiologico Monzino, IRCCS, Milan, Italy; Cardiovascular Section, Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.
authors.forename: Mauro
authors.initials: M
authors.lastname: Pepi
authors.affiliation: Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands; Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: Victoria
authors.initials: V
authors.lastname: Delgado
authors.affiliation: Centro Cardiologico Monzino, IRCCS, Milan, Italy; Cardiovascular Section, Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.
authors.forename: Gloria
authors.initials: G
authors.lastname: Tamborini
authors.affiliation: Centro Cardiologico Monzino, IRCCS, Milan, Italy; Cardiovascular Section, Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.
authors.forename: Laura
authors.initials: L
authors.lastname: Fusini
authors.affiliation: Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands; Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: Arend
authors.initials: A
authors.lastname: de Weger
authors.affiliation: Centro Cardiologico Monzino, IRCCS, Milan, Italy; Cardiovascular Section, Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.
authors.forename: Paola
authors.initials: P
authors.lastname: Gripari
authors.affiliation: Centro Cardiologico Monzino, IRCCS, Milan, Italy; Cardiovascular Section, Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Bartorelli
authors.affiliation: Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands; Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: Jeroen J
authors.initials: JJ
authors.lastname: Bax
authors.affiliation: Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands; Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, The Netherlands. Electronic address: n.ajmone@lumc.nl.
authors.forename: Nina Ajmone
authors.initials: NA
authors.lastname: Marsan
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001022:Aortic Valve Insufficiency / Q000000981:diagnostic imaging / Q000209:etiology* / Q000401:mortality*; D001024:Aortic Valve Stenosis / Q000401:mortality / Q000601:surgery*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012720:Severity of Illness Index; D015996:Survival Rate; D065467:Transcatheter Aortic Valve Replacement / Q000009:adverse effects*; D016896:Treatment Outcome; D014463:Ultrasonography