title: Does pre-existing aortic regurgitation protect from death in patients who develop paravalvular leak after TAVI?
abstract: OBJECTIVE
  The aim of this study was to investigate interactions among pre-procedural aortic regurgitation (AR), post-procedural paravalvular leak (PVL) and long-term clinical outcomes.
  
  
  RESULTS
  We analyzed data prospectively collected in the Italian Transcatheter balloon-Expandable Registry (ITER) on aortic stenosis (AS) patients. The degree of pre-procedural AR and post-procedural PVL was stratified as: absent/trivial, mild, and moderate/severe. VARC definitions were applied to outcomes. Of 1708 patients, preoperatively, AR was absent/trivial in 40% of the patients, mild in 42%, and moderate in 18%. Postoperatively, PVL was moderate-severe in 5%, mild in 32% of patients, and absent/trivial in 63%. Clinical follow-up, median 821days (IQR 585.75), was performed in 99.7% of patients. PVL, but not preoperative AR, was a major predictor of adverse outcome (HR 1.33, CI 95% 0.9-2.05, p=0.012 for mild PVL, HR 1.36, CI 95% 0.9-2.05, p<0.001 for PVL≥moderate and OR 1.04, p=0.97 respectively). Patients with moderate-severe PVL and preoperative left ventricle (LV) dilatation (LVEDVi>75ml/m2) showed better survival than those without dilatation (HR 8.63, p=0.001).
  
  
  CONCLUSIONS
  In patients with severe AS treated with balloon-expandable TAVI, the presence of PVL, but not pre-procedural AR, was a major predictor of adverse outcome. Preoperative LV dilatation seemed to offer some clinical advantages.
authors.affiliation: Department of Cardiology, Thoracic and Vascular Sciences, University of Padua, Padua, Italy. Electronic address: colli.andrea.bcn@gmail.com.
authors.forename: Andrea
authors.initials: A
authors.lastname: Colli
authors.affiliation: Department of Cardiology, Thoracic and Vascular Sciences, University of Padua, Padua, Italy.
authors.forename: Laura
authors.initials: L
authors.lastname: Besola
authors.affiliation: Division of Cardiac Surgery, San Giovanni Battista Hospital 'Molinette', University of Turin, Turin, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Salizzoni
authors.affiliation: Department of Cardiology, Thoracic and Vascular Sciences, University of Padua, Padua, Italy.
authors.forename: Dario
authors.initials: D
authors.lastname: Gregori
authors.affiliation: Department of Cardiology, Thoracic and Vascular Sciences, University of Padua, Padua, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Tarantini
authors.affiliation: Department of Clinical Sciences and Community Health, Cardiac Surgery, University of Milan, Centro Cardiologico Monzino Hospital, Milan, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Agrifoglio
authors.affiliation: Division of Metabolic and Cardiovascular Sciences, San Raffaele Scientific Institute, Milan, Italy.
authors.forename: Alaide
authors.initials: A
authors.lastname: Chieffo
authors.affiliation: Division of Cardiac Surgery, San Martino University Hospital, University of Genova, Genova, Italy.
authors.forename: Tommaso
authors.initials: T
authors.lastname: Regesta
authors.affiliation: Clinical Surgical Cardiology and Thoracic Vascular Department, Hesperia Hospital, Modena, Italy.
authors.forename: Davide
authors.initials: D
authors.lastname: Gabbieri
authors.affiliation: Department of Cardiology, Policlinico S. Orsola-Malpighi, University of Bologna, Bologna, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Saia
authors.affiliation: Division of Cardiology, Ferrarotto Hospital, Catania, Catania, Italy.
authors.forename: Corrado
authors.initials: C
authors.lastname: Tamburino
authors.affiliation: Division of Cardiology of the Department of Medicine, University of Verona, Verona, Italy.
authors.forename: Flavio
authors.initials: F
authors.lastname: Ribichini
authors.affiliation: Cardiovascular Department, AO Papa Giovanni XXIII, Bergamo, Italy.
authors.forename: Orazio
authors.initials: O
authors.lastname: Valsecchi
authors.affiliation: Interventional Cardiology Unit, AO Brotzu, Cagliari, Italy.
authors.forename: Bruno
authors.initials: B
authors.lastname: Loi
authors.affiliation: Department of Cardiovascular Diseases, Le Scotte University Hospital, University of Siena, Siena, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Iadanza
authors.affiliation: Interventional Cardiology Unit, Careggi University Hospital, Florence, Italy.
authors.forename: Miroslava
authors.initials: M
authors.lastname: Stolcova
authors.affiliation: Division of Cardiac Surgery, Azienda Ospedaliera-Universitaria, Trieste, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Minati
authors.affiliation: Division of Cardiac Surgery, Santa Maria Hospital, Bari, Italy.
authors.forename: Gianluca
authors.initials: G
authors.lastname: Martinelli
authors.affiliation: Department of Cardiology, Clinical Institute S. Ambrogio, Milan, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Bedogni
authors.affiliation: Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy.
authors.forename: Anna
authors.initials: A
authors.lastname: Petronio
authors.affiliation: Division of Cardiology, S. Chiara Hospital, Trento, Italy.
authors.forename: Michele
authors.initials: M
authors.lastname: Dallago
authors.affiliation: Division of Cardiac Surgery, Humanitas Research Hospital, Milan, Italy.
authors.forename: Antioco
authors.initials: A
authors.lastname: Cappai
authors.affiliation: Department of Cardiology, Thoracic and Vascular Sciences, University of Padua, Padua, Italy.
authors.forename: Augusto
authors.initials: A
authors.lastname: D'Onofrio
authors.affiliation: Department of Cardiology, Thoracic and Vascular Sciences, University of Padua, Padua, Italy.
authors.forename: Gino
authors.initials: G
authors.lastname: Gerosa
authors.affiliation: Division of Cardiac Surgery, San Giovanni Battista Hospital 'Molinette', University of Turin, Turin, Italy.
authors.forename: Mauro
authors.initials: M
authors.lastname: Rinaldi
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000601:surgery*; D001022:Aortic Valve Insufficiency / Q000150:complications / Q000175:diagnosis / Q000401:mortality*; D001024:Aortic Valve Stenosis / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D004452:Echocardiography; D005260:Female; D005500:Follow-Up Studies; D006350:Heart Valve Prosthesis / Q000009:adverse effects*; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008297:Male; D011183:Postoperative Complications / Q000175:diagnosis / Q000209:etiology / Q000401:mortality*; D011379:Prognosis; D011446:Prospective Studies; D011474:Prosthesis Design; D012042:Registries; D012307:Risk Factors; D012720:Severity of Illness Index; D015996:Survival Rate / Q000639:trends; D065467:Transcatheter Aortic Valve Replacement / Q000009:adverse effects*
keywords: Aortic valve regurgitation; Aortic valve stenosis; Paravalvular leakage; TAVI; TAVR