Original Title: Aortic Regurgitation Following Transcatheter Aortic Valve Replacement: Impact of Preprocedural Left Ventricular Diastolic Filling Patterns on Late Clinical Outcomes.
Reference: Amir Halkin, et al. Catheterization Cardiovascular Intervention 2016;87:1156-1163.
Courtesy of Dr. Carlos Fava.
Even though the mechanisms underlying post TAVI aortic regurgitation (ARpost) remain unclear, there is no question this complication is associated to major mortality due to rapid rise of LV end diastolic pressure.
This study analyzed 418 patients with symptomatic severe aortic stenosis undergoing transcatheter aortic valve replacement (318 received the CoreValve and 100 got the Sapiens XT). Population baseline characteristics were similar and all patients were accessed via femoral approach.
At the end of procedure:
• 206 patients (49.3%) did not present ARpost.
• 150 patients (35.9%) presented mild ARpost.
• 62 patients (14.9%) presented moderate/severe ARpost.
AR was more prevalent with the balloon-expandable valve.
Follow up was at 30 months and there were higher all-cause mortality and higher combined events rates in patients presenting moderate/severe ARpost compared to the groups with none or mild ARpost.
P=0.02
• Mortality associated to moderate or severe ARpost: 38%
• Mortality associated to patients without ARpost: 22%
• Mortality associated to mild ARpost: 21%
P=0.01
• Combined events associated to moderate/severe ARpost: 56%
• Combined events associated patients with no ARpost: 35%
• Combined events associated to mild ARpost: 40%
In multivariable analyzis, LV deceleration<160 ms. was associated to mortality and combined events in patients presenting moderate/severe ARpost.
Conclusion
Shorter LV filling time has an adverse prognosis in TAVI patients developing ARpost, independently of other clinical and echocardiographic variable, including regurgitation or diastolic function severity.
Editorial Comment
The presence of moderate/severe ARpost impacts evolution, especially due to increased preload in a hypertrophic and more rigid LV.
The new valves have successfully reduced it; this has been an important advance since nowadays younger patients at lower risk are being treated with TAVI.
Courtesy of Dr. Carlos Fava. Favaloro Foundation. Buenos Aires, Argentina.