title: The interaction of de novo and pre-existing aortic regurgitation after TAVI: insights from a new quantitative aortographic technique.
abstract: OBJECTIVE
  The aim of this study was to evaluate the intermediate-term clinical impact of aortic regurgitation (AR) after transcatheter aortic valve implantation (TAVI) using a novel quantitative angiographic method taking into account the influence of pre-existing AR.
  
  
  RESULTS
  AR after TAVI was quantified in 338 patients (age 82 [78-86] years; 55% male) and the influence on intermediate-term all-cause mortality was evaluated. In 228 aortograms, AR was quantitated using a dedicated videodensitometric method focused in the left ventricular outflow tract (LVOT-AR). Patients with LVOT-AR >0.17 had a significantly increased all-cause mortality at three years, compared with patients who had LVOT-AR ≤0.17 (adjusted hazard ratio [HR]: 1.73, 95% confidence interval [CI]: 1.05-2.86, p=0.032). Taking the influence of pre-existing AR into account, patients with post-procedural LVOT-AR >0.17 and ≤mild pre-existing AR had a significantly increased mortality at two years, compared to patients with LVOT-AR >0.17 and >mild pre-existing AR (HR: 2.55, 95% CI: 1.16-5.58, p=0.029). In those with >mild pre-existing AR (n=70), post-TAVI LVOT-AR >0.17 was not associated with increased mortality (HR: 0.77, 95% CI: 0.31-1.91, p=0.578).
  
  
  CONCLUSIONS
  AR after TAVI could be quantitated utilising LVOT-AR. The cut-point of >0.17 indicates a significant AR pertaining to increased intermediate-term mortality, especially in those with no significant pre-existing AR.
authors.affiliation: Thoraxcenter, Erasmus Medical Center, Rotterdam, the Netherlands.
authors.forename: Hiroki
authors.initials: H
authors.lastname: Tateishi
authors.forename: Mohammad
authors.initials: M
authors.lastname: Abdelghani
authors.forename: Rafael
authors.initials: R
authors.lastname: Cavalcante
authors.forename: Yosuke
authors.initials: Y
authors.lastname: Miyazaki
authors.forename: Carlos M
authors.initials: CM
authors.lastname: Campos
authors.forename: Carlos
authors.initials: C
authors.lastname: Collet
authors.forename: Tristan L B
authors.initials: TLB
authors.lastname: Slots
authors.forename: Rogério S
authors.initials: RS
authors.lastname: Leite
authors.forename: José A
authors.initials: JA
authors.lastname: Mangione
authors.forename: Alexandre
authors.initials: A
authors.lastname: Abizaid
authors.forename: Osama I I
authors.initials: OII
authors.lastname: Soliman
authors.forename: Ernest
authors.initials: E
authors.lastname: Spitzer
authors.forename: Yoshinobu
authors.initials: Y
authors.lastname: Onuma
authors.forename: Patrick W
authors.initials: PW
authors.lastname: Serruys
authors.forename: Pedro A
authors.initials: PA
authors.lastname: Lemos
authors.forename: Fabio S
authors.initials: FS
authors.lastname: de Brito
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000601:surgery; D001022:Aortic Valve Insufficiency / Q000209:etiology*; D001024:Aortic Valve Stenosis / Q000601:surgery*; D006328:Cardiac Catheterization / Q000379:methods; D005260:Female; D006350:Heart Valve Prosthesis / Q000009:adverse effects*; D006801:Humans; D008297:Male; D012307:Risk Factors; D065467:Transcatheter Aortic Valve Replacement / Q000009:adverse effects