title: Impact and natural history of postprocedural aortic regurgitation on early and midterm mortality following transcatheter aortic valve implantation in high-risk patients with severe aortic stenosis.
abstract: BACKGROUND
  Post-procedural aortic regurgitation (AR) negatively impacts the prognosis after trans-catheter aortic valve implantation. However, data evaluating the impact of different post-procedural AR grades (particularly mild) on clinical outcomes are still important.
  
  
  OBJECTIVE
  A retrospective cohort analysis was performed on all consecutive patients with severe aortic stenosis who underwent trans-catheter aortic valve implantation between July 2008 and August 2011 in a single Institution. Aim of the study was to evaluate the impact of different post-procedural AR grades on early and mid-term clinical outcomes.
  
  
  RESULTS
  322 consecutive patients were evaluated. At post-procedural echocardiographic evaluation: 105 (32.6%) patients had no AR, 204 (63.4%) mild AR and 13 (4%) moderate/severe AR. In-hospital mortality was higher in patients with moderate/severe AR than in those with absent or mild AR (38.5% vs. 2.6%, P < 0.001). At a median clinical follow-up of 342 days [interquartile range 93-485] cardiovascular mortality was 2.9% in patients without AR; 13.2% in the mild AR group (P = 0.004 vs. absent AR) and 46.2% in the moderate/severe AR group (P < 0.001 vs. mild or absent AR). On multivariable analysis, post-procedural AR (hazard ratio = 2.65 absent vs. present any grade, 95% confidence interval = 1.11-6.29; P = 0.027) was an independent predictor of mid-term mortality.
  
  
  CONCLUSIONS
  The impact of post-procedural AR on outcomes after trans-catheter aortic valve implantation is proportional with its grade even in case of mild post-procedural AR compared to absent. This study confirms that every effort should be made to reduce the grade of post-procedural AR after trans-catheter aortic valve implantation with current devices.
authors: aInterventional Cardiology Unit, San Raffaele Scientific Institute bInterventional Cardiology Unit, EMO-GVM Centro Cuore Columbus cDivision of Cardiac Surgery, San Raffaele Scientific Institute, Milan, Italy *Dr Alfonso Ielasi and Dr Azeem Latib contributed equally to the article and are joint first authors.
authors: Alfonso
authors: A
authors: Ielasi
authors: Azeem
authors: A
authors: Latib
authors: Francesco Maria
authors: FM
authors: Sacco
authors: Charis
authors: C
authors: Costopoulos
authors: Filippo
authors: F
authors: Figini
authors: Antonio
authors: A
authors: Grimaldi
authors: Charbel
authors: C
authors: Naim
authors: Francesco
authors: F
authors: Maisano
authors: Alaide
authors: A
authors: Chieffo
authors: Matteo
authors: M
authors: Montorfano
authors: Ottavio
authors: O
authors: Alfieri
authors: Antonio
authors: A
authors: Colombo
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000473:pathology / Q000601:surgery*; D001022:Aortic Valve Insufficiency / Q000453:epidemiology / Q000209:etiology / Q000401:mortality* / Q000503:physiopathology*; D001024:Aortic Valve Stenosis / Q000503:physiopathology / Q000601:surgery*; D006328:Cardiac Catheterization / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D011183:Postoperative Complications / Q000401:mortality*; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors; D065467:Transcatheter Aortic Valve Replacement / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D016896:Treatment Outcome