title: Five-year evolution of mild aortic regurgitation following transcatheter aortic valve implantation: early insights from a single-centre experience.
abstract: To assess the follow-up evolution and impact of mild aortic regurgitation (1 + AR) following transcatheter aortic valve implantation (TAVI).
  
  
  
  We evaluated the follow-up outcomes and AR evolution of 558 patients affected by native aortic stenosis who underwent TAVI with residual AR ≤ 1+.
  
  
  
  No residual AR was found in 294 (52.7%) patients, whereas 1 + AR was found in 264 (47.3%) patients. At 5.5 years, freedom from all-cause mortality (56.9% vs 53.5%), cardiac mortality (75.0% vs 74.3%) and heart failure (70.0% vs 63.9%) were similar between no-AR and 1 + AR groups, respectively (all P  > 0.05). New York Heart Association Class I-II was found in 88.9% vs 82.4% of patients respectively ( P  = 0.013). Freedom from AR ≥3+ at 5.5 years was 98.6% in the no-AR group vs 82.5% in the 1 + AR group (log-rank <0.001). Residual 1 + AR was found to be an independent predictor of increased follow-up AR ≥3+ ( P  = 0.012). In 1 + AR group, higher left ventricle mass index independently predicted increased cardiac death [hazards ratio (HR) 1.01, confidence interval (CI) 1.00-1.02, P  = 0.036] and heart failure rate (HR 1.01, CI 1.00-1.02, P  = 0.002), while larger native aortic annulus perimeter predicted follow-up AR ≥ 3+ (HR 1.12, CI 1.02-1.22, P  = 0.016).
  
  
  
  5 years after TAVI, a higher progression of paravalvular AR to Grade ≥3+ together with worse symptoms were found in patients with residual 1 + AR compared with no-AR, although no marked difference in survival was observed. These findings raise further concerns about 1+ residual AR after TAVI, especially in the perspective of expanding indications to younger low-risk patients. Mechanisms that cause progression of paravalvular AR after TAVI remain to be clarified.
authors.affiliation: Department of Cardiac Surgery, San Raffaele Scientific Institute, Milan, Italy.
authors.forename: Nicola
authors.initials: N
authors.lastname: Buzzatti
authors.affiliation: Department of Cardiac Surgery, San Raffaele Scientific Institute, Milan, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Castiglioni
authors.affiliation: Department of Echocardiography, San Raffaele Scientific Institute, Milan, Italy.
authors.forename: Eustachio
authors.initials: E
authors.lastname: Agricola
authors.affiliation: Department of Echocardiography, San Raffaele Scientific Institute, Milan, Italy.
authors.forename: Marta
authors.initials: M
authors.lastname: Barletta
authors.affiliation: Department of Echocardiography, San Raffaele Scientific Institute, Milan, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Stella
authors.affiliation: Department of Interventional Cardiology, San Raffaele Scientific Institute, Milan, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Giannini
authors.affiliation: Department of Interventional Cardiology, San Raffaele Scientific Institute, Milan, Italy.
authors.forename: Damiano
authors.initials: D
authors.lastname: Regazzoli
authors.affiliation: Department of Interventional Cardiology, San Raffaele Scientific Institute, Milan, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Mangieri
authors.affiliation: Department of Interventional Cardiology, San Raffaele Scientific Institute, Milan, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Ancona
authors.affiliation: Department of Radiology, San Raffaele Scientific Institute, Milan, Italy.
authors.forename: Pietro
authors.initials: P
authors.lastname: Spagnolo
authors.affiliation: Department of Interventional Cardiology, San Raffaele Scientific Institute, Milan, Italy.
authors.forename: Alaide
authors.initials: A
authors.lastname: Chieffo
authors.affiliation: Department of Interventional Cardiology, San Raffaele Scientific Institute, Milan, Italy.
authors.forename: Matteo
authors.initials: M
authors.lastname: Montorfano
authors.affiliation: Department of Cardiac Surgery, San Raffaele Scientific Institute, Milan, Italy.
authors.forename: Ottavio
authors.initials: O
authors.lastname: Alfieri
authors.affiliation: Department of Interventional Cardiology, San Raffaele Scientific Institute, Milan, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Colombo
authors.affiliation: Department of Interventional Cardiology, San Raffaele Scientific Institute, Milan, Italy.
authors.forename: Azeem
authors.initials: A
authors.lastname: Latib
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001022:Aortic Valve Insufficiency / Q000175:diagnosis* / Q000209:etiology / Q000401:mortality; D001024:Aortic Valve Stenosis / Q000175:diagnosis / Q000601:surgery*; D002423:Cause of Death / Q000639:trends; D005260:Female; D005500:Follow-Up Studies; D006350:Heart Valve Prosthesis / Q000009:adverse effects*; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008297:Male; D011183:Postoperative Complications; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D065467:Transcatheter Aortic Valve Replacement / Q000009:adverse effects*
keywords: Mild; Outcomes; Regurgitation; TAVI