title: Aortic regurgitation with second versus third-generation balloon-expandable prostheses in patients undergoing transcatheter aortic valve implantation.
abstract: OBJECTIVE
  Our aim was to assess the incidence of aortic regurgitation (AR) after transcatheter aortic valve implantation (TAVI) with the second (SXT) versus third-generation (S3) balloon-expandable SAPIEN prosthesis in patients with symptomatic aortic stenosis (AS).
  
  
  RESULTS
  Of 634 patients undergoing TAVI in our centre from May 2010 to July 2014, 354 were treated with the SXT and 100 with the S3 prosthesis. The primary outcome was the incidence of more-than-mild post-TAVI AR at discharge. Secondary outcomes were 30-day incidence of all-cause death, any bleeding complications and need for new pacemaker. The incidence of the primary outcome was 2.0% vs. 8.8%, p<0.01 with S3 compared to SXT, and S3 use was the only independent predictor of post-TAVI AR (odds ratio 0.54; 95% CI: 0.33 to 0.89). At 30 days, there were no differences in mortality (1.0% vs. 4.2%, p=0.13) and pacemaker rate (12.0% vs. 10.5%, p=0.59) between S3 and SXT. S3-treated patients less frequently had bleeding complications (24.0% vs. 41.8%, p<0.01) and more often had permanent new left bundle branch block (22.0% vs. 7.1%, p<0.001).
  
  
  CONCLUSIONS
  Compared to the SXT, the use of the S3 prosthesis substantially reduces post-TAVI aortic regurgitation. Longer follow-up is needed to assess if this finding translates to better clinical outcomes.
authors.affiliation: Department of Cardiology, Munich University Clinic, Ludwig-Maximilian University, Munich, Germany.
authors.forename: David
authors.initials: D
authors.lastname: Jochheim
authors.forename: Magda
authors.initials: M
authors.lastname: Zadrozny
authors.forename: Hans
authors.initials: H
authors.lastname: Theiss
authors.forename: Moritz
authors.initials: M
authors.lastname: Baquet
authors.forename: Fatima
authors.initials: F
authors.lastname: Maimer-Rodrigues
authors.forename: Axel
authors.initials: A
authors.lastname: Bauer
authors.forename: Philipp
authors.initials: P
authors.lastname: Lange
authors.forename: Martin
authors.initials: M
authors.lastname: Greif
authors.forename: Christian
authors.initials: C
authors.lastname: Kupatt
authors.forename: Jörg
authors.initials: J
authors.lastname: Hausleiter
authors.forename: Christian
authors.initials: C
authors.lastname: Hagl
authors.forename: Steffen
authors.initials: S
authors.lastname: Massberg
authors.forename: Julinda
authors.initials: J
authors.lastname: Mehilli
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001022:Aortic Valve Insufficiency / Q000453:epidemiology*; D001024:Aortic Valve Stenosis / Q000628:therapy*; D006328:Cardiac Catheterization / Q000009:adverse effects*; D005260:Female; D006350:Heart Valve Prosthesis / Q000009:adverse effects; D019918:Heart Valve Prosthesis Implantation / Q000379:methods; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D065467:Transcatheter Aortic Valve Replacement / Q000009:adverse effects*; D016896:Treatment Outcome